Pharmacist-Led Intervention Aids in Successful Approach to Opioid Tapering

Successful opioid tapering requires a multidisciplinary approach, according to research presented at ACR Convergence 2021, the annual meeting of the American College of Rheumatology.¹

As disease-modifying antirheumatic drugs (DMARDs) have evolved, the need for opioid therapies in rheumatology care have decreased. However, according to researchers, some health care professionals are treating patients who began chronic opioid therapy prior to DMARD availability, necessitating the implementation of an opioid tapering plan.

In the current study, a pharmacy team from Albany, New York developed a 3-phase program, which included provider and staff education, workflow updates, and the implementation of “individualized patient taper plans.” As plans were implemented, the pharmacy team both served as a continuous resource for fellow health care providers and worked directly with patient participants.

Implementation of the 3-phase plan began in 2019, with 3 provider and staff education sessions held in June, October, and December 2019, with changes in the controlled substance contract workflow were implemented in December 2019. At baseline, there were no signed contracts; to date, a total of 253 signed controlled substance contracts—including those for tramadol and pregabalin—have been documented in electronic health records.

As of April 2021, 124 patients have active opioid prescriptions, including prescriptions for codeine, hydrocodone, oxycodone, methadone, or morphine. Since program implementation, 6, 33, and 10 patients, respectively, discontinued opioids prescribed by their health care provider during 2019, 2020, or 2021, respectively, and a total of 19 patients have been enrolled in the pharmacist-led opioid taper service.

At baseline, daily doses ranged from 20 to 200 morphine equivalent daily doses. To date, 5 patients have successfully tapered off opioids and 9 have had reductions in their morphine equivalent daily dose.

At baseline, a total of 9 patients enrolled in the program had a morphine equivalent daily dose greater than or equal to 90; of those patients, 56% have reduced their dose to below 90 and 2 patients no longer require opioid therapy. The average morphine equivalent daily dose reduction for all enrolled patients was 48%.

Average duration of enrollment is 11 months (range, 5-20 months). The duration of opioid taper for patients who successfully tapered their opioid therapy ranged from 1 to 3 months.

“Successful opioid tapering is a time intensive process and requires a multidisciplinary approach,” the researchers concluded. “This provides an opportunity for pharmacists to play an essential role as part of a team-based approach to ensure a successful opioid taper or discontinuation while minimizing adverse events.”

Reference

1. Farrell J, Miller M, Hennig K, McCarthy K, Katche CA, Cleary J. Pharmacist-led multidisciplinary approach to opioid tapering in a private rheumatology practice: Patient outcomes. Presented at: ACR Convergence 2021; November 3-9, 2021. Abstract 1064.