Australasian Chapter of Addiction Medicine
The Australasian Chapter of Addiction Medicine (AChAM) is a Chapter of the Royal Australasian College of Physicians (RACP) Adult Internal Medicine Division that connects and represents Addiction Medicine Fellows and trainees in Australia and New Zealand. AChAM advances the study of addiction medicine in Australia and New Zealand through training, research and collaboration with health professionals and organisations. The Chapter provides training and continuing professional development to ensure excellence in skills, expertise, and ethical standards. AChAM advocates on behalf of its members and acts as an authoritative body for consultation in addiction medicine to ensure quality care for individuals with addiction disorders.
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Do not deprescribe or stop opioid treatment in a patient with concurrent chronic pain and opioid dependence without considering the impact on morbidity and mortality from discontinuation of opioid medications
Do not deprescribe or stop opioid treatment in a patient with concurrent chronic pain and opioid dependence without considering the impact on morbidity and mortality from discontinuation of opioid medications
Efforts to reduce opioid-related harm must be carefully balanced against considerations of potential harms that might result from abrupt discontinuation or rapid tapering of drug dosages. These include risks related to withdrawal symptoms and increased pain as well as to seeking other, at time more dangerous, sources of opioids. The adverse physical and psychological outcomes of abrupt reduction or discontinuation of long-time medication include uncontrolled pain, related loss of function and quality of life, depression, accidental overdose and suicide. Clinical decisions must account for unique circumstances of patients as clinicians compassionately work with them to minimise opioid-related harms, be it by mitigating risks associated with high-dose opioids for patients who continue to use them, dosing at a rate minimising withdrawal symptoms for those who agree to taper and/or maximising non-opioid treatment options as appropriate.
Supporting evidence
Dowell D, Haegerich T, Chou R No Shortcuts to Safer Opioid Prescribing. N Engl J Med June 2019.
Kroenke K, Alford A, at al Challenges with Implementing the Centers for Disease Control and Prevention Opioid Guideline: A Consensus Panel Report. Pain Medicine, Volume 20, Issue 4, April 2019.
How this list was made
Through the RACP Evolve program, the Chapter Committee of the Australasian Chapter of Addiction developed a draft Evolve Top-5 Recommendations of low-value practices and interventions that pertain to the specialty. After several rounds of internal consultations and revisions, the list of recommendations was subject to an extensive review process that involved key College societies with an interest or professional engagement with addiction medicine.
The list was then consulted with other medical colleges including through Choosing Wisely Australia. The recommendations were also reviewed by the College’s Aboriginal and Torres Strait Islander Health Committee to ensure that the list adequately reflects the health needs of Indigenous Australians with substance use disorders.
Feedback received in the consultations led to further fine tuning of the list, which was then finalised and approved by the AChAM President and President-Elect.
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1
Do not undertake elective withdrawal management in the absence of a post-withdrawal treatment plan agreed with the patient that addresses their substance use and related health issues.
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2
Do not prescribe pharmacotherapies as stand-alone treatment for Substance Use Disorders (SUD) but rather as part of a broader treatment plan that identifies goals of treatment, incorporates psychosocial interventions and identifies how outcomes will be monitored
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3
Do not deprescribe or stop opioid treatment in a patient with concurrent chronic pain and opioid dependence without considering the impact on morbidity and mortality from discontinuation of opioid medications
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4
While managing patients with Substance Use Disorder (SUD), exercise caution in the use of treatment approaches that are not supported by current evidence or involve unlicensed therapeutic products.
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5
Use a 'universal precautions' approach for all psychoactive medications that have known potential or liability for abuse including opioids, benzodiazepines, antipsychotic medications, gabapentinoids, cannabinoids and psychostimulants.