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Nurse-led interventions help one in five taper opioids

Nurse-led interventions help one in five taper opioids

Nurse-led interventions consisting of one-to-one sessions and group support helped one in five people stop taking opioids without any increase in pain, a landmark study has found.

Researchers from the University of Warwick and The James Cook University Hospital, Middlesbrough, found that patients could be supported to ‘significantly’ reduce opioid use without pharmaceutical intervention.

Between 2017 and 2020, over 600 patients recruited from 191 general practices received either ‘enhanced usual care’ or an intervention programme designed to guide patients in coming off opioids, taper their intake, and self-manage pain symptoms.

After a year, 29% of those taking part in the intervention programme were able to fully come off opioids, compared with only 7% of those in the control group receiving GP care and a self-help booklet and CD.

Funded by the National Institute for Health and Care Research (NIHR), the study aimed to investigate whether rapid tapering without pharmaceutical intervention or increased pain was possible through ‘multimodal treatment approaches’.

Professor Harbinder Sadhu, associate professor of health psychology at the University of Warwick, who led the clinical trial told Nursing in Practice that the biggest lesson was that ‘we were able to deliver this in primary care’.

Professor Sadhu explained that the intervention programme was delivered by a nurse and a layperson who both received specialist training to deliver the support.

The nurse was then responsible for creating a tapering regime, using a purpose-built app which helped calculate tapering opioid doses. After the GP signed off on the programme, the nurse delivered the guidance for the group sessions and one-on-one support.

‘One of the things we found with the programme is that people really valued having support. Having that monitoring from a nurse and having those telephone calls and face-to-face sessions during the tapering was really important,’ said Professor Sadhu.

He said that there was a danger that a lack of guidance on how to taper people off safely could lead to higher prescribing rates which create long term health risks for patients without significantly reducing their pain.

The study found that there was no difference in pain between those who tapered off opioids through the intervention programme and those who did not.

Additionally, those taking part in the intervention had significant improvements in mental health and health related quality of life.

Looking ahead, Professor Sadhu told Nursing in Practice that the next step would be wider implementation of the programme.

‘We need to think about the next steps of implementation and training; offering the training that’s needed for GPs as well as nurses and being able to use that collaborative working in multidisciplinary teams,’ he said.

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