Dose reduction of long-term opioids: our duty as clinicians

摘要

We are all aware of the harm associated with long-term prescriptions of opioids and the potential for opioid dependence. Protracted use of opioids is associated with a host of adverse effects, including a 7-fold increase in mortality in patients taking 100 mg/24 hour of morphine (or equivalent), compared with doses equivalent to <20 mg/24 hour. Moreover, long-term opioid use does not improve quality of life, pain, or functioning in patients with chronic non-cancer pain. Where pain remains uncontrolled with doses equivalent to 120 mg/24 hour morphine, the patient should be considered non-opioid responsive. In view of the evidence, can we honestly say that we are doing enough to encourage reduction and withdrawal of opioids in our patients?