GPs play an important role in minimising risk of misuse of opioid-based analgesics by avoiding (or deprescribing) opioids in accordance with best practice guidelines and government regulation.
Each year an estimated two million Australians commence opioid-based analgesics, with 50,000 subsequently developing long-term opioid use.
One group at risk of developing long-term use of opioid analgesics are those who are commenced on opioid analgesics in a chronic preoperative pain context. This group are at risk of developing long-term opioid persistence depending on nature of the opioid used. A further significant predictive factor of opioid persistence is prescription duration.
Persistent opioid use is not necessarily correlated with clinically significant improvements in pain/function and is associated with harms that increase with higher dose, and over time place patients at increased risk.
Evidence indicates that harms related to pharmaceutical opioid use can vary substantially across opioid types, where differing pharmacological profiles of opioids result in differences in side effects and the likelihood of developing long-term use.
Identification of factors that contribute to pain per se, and related opioid persistence including the contribution of different opioid types may help to ensure a more personalised approach to meet the analgesic needs of patients requiring pre-operative opioid use.