22-24 – Tapering opioids in chronic non-cancer pain: systematic review of barriers and facilitators

Opioids are commonly prescribed for the management of chronic non-cancer pain. However, current evidence does not support their long-term use and people taking opioids may need support to reduce or stop their use. This systematic literature review for barriers and facilitators of tapering interventions aimed to identify strategies that will support patients, their carers and healthcare professionals to safely and effectively reduce or discontinue patient opioid use.
We searched databases, trial registries & websites up to September 2022 for studies of barriers and facilitators of tapering interventions to safely and effectively reduce or discontinue opioid use in adults with chronic non-cancer pain and prescription opioid use greater than 3 months. 16 studies (10 qualitative studies, 5 mixed-methods and 1 quantitative study) were identified. Most studies (12/16) reported barriers and facilitators of tapering interventions generally and 4 studies reported barriers and facilitators of a specific tapering intervention. 13 studies were of moderate to high quality, two studies had major limitations and one study was of low quality. Eight barriers (including lack of patient knowledge and motivation, negative expectations and burden) and eight facilitators (including patient knowledge, ability to taper and patient-led treatment) were identified and were agreed by our stakeholders.
The identified barriers and facilitators highlight the complexity of opioid tapering with the potential for multiple interdependent, behavioural, structural and contextual barriers to arise. Care that recognises the complexity of tapering and is patient-centred may be more likely to achieve safe and effective opioid tapering. Patient and healthcare professional willingness to taper and the patient’s ability to maintain taper is essential for the successful tapering. The design and delivery of successful opioid tapering interventions requires careful consideration of individual-level factors.