New study: Educational intervention reduces opioid doses and mortality

Monash University

A new study led by a Monash University researcher in collaboration with the Manitoba Government Department of Health, Canada, has shown a government-led educational intervention to effectively reduce opioid use and mortality among people who regularly fill prescriptions for opioid medications.

The Canada-based randomised controlled trial, led by Dr Justin Turner from the Centre for Medicine Use and Safety (CMUS) within the Monash Institute of Pharmaceutical Sciences (MIPS), measured the impact of mailing an educational brochure to long-term prescription opioid users, excluding those receiving palliative care, a cancer diagnosis and people living with dementia.

The brochure contained educational material on chronic pain, long-term opioid use risks, self-management strategies and resources available for tapering. Over the course of six months, participants who received the educational brochure reduced their opioid dose and had lower mortality compared to those who didn’t receive the brochure. The intervention was particularly effective for males, those aged under 65 years, or living in urban areas.

Dr Turner, who works to reduce medication-related harm, said although the study was conducted in Canada, Australia also has a large opioid problem and there is potential for Australian governments to test this approach.

“Our study highlights the potential to educate and empower individuals to make informed decisions about their opioid use,” said Dr Turner.

“In Australia, around 13.3 million opioid scripts were dispensed to 2.9 million people for pain relief in 2021-22. While opioids have their place in the management of acute pain, long-term use presents significant risks and has claimed many lives.

“By providing evidence-based information directly to patients, we observed a notable decrease in opioid doses among people who received the brochure. A subsequent analysis showed a drop in mortality from all causes among brochure recipients, which is an important finding that should be investigated further.”

By partnering with the Manitoba government, the study investigators were able to include all 4,225 adults in Manitoba who regularly filled prescriptions for opioid medications. While more individuals who received the brochure reduced the dose of their opioids compared to people who did not receive the brochure, the proportion of people who completely stopped taking their prescription opioids was the same in both groups.

“The aim of the intervention initiative was not to get everybody to completely stop taking opioids, but rather for patients and healthcare professionals to review the individual’s need to be on them and, where appropriate, reduce or possibly even work toward stopping altogether,” said Dr Turner.

“This is possible for many people where the opioid is not providing adequate pain relief, or the adverse effects outweigh the benefits. When you look at the data, in many instances opioids are being prescribed where there is a dearth of clinical trial data to support their effectiveness – these are the people we are hoping to reach and move them to more appropriate treatment.”

Dr Turner concludes “While the intervention was successful, it’s possible that addressing patients and healthcare providers together may enable greater rates of opioid cessation. There have been significant advancements in Australia recently with the release of the first international opioid deprescribing guideline for health professionals.”

Université de Montréal’s Dr Cara Tannenbaum, a Senior Author and co-founder and co-director of the Canadian Deprescribing Network, said the results underscore the importance of patient education in promoting the appropriate use of medications.

“By engaging patients in their treatment decisions and providing them with the necessary information, we can contribute to safer and more effective opioid management strategies,” said Dr Tannenbaum.

The publication of this study in JAMA Network Open marks a significant milestone in the ongoing efforts to address harms resulting from opioid analgesic use and improve patient outcomes.

/Public Release.