The Six Rs of Managing High-Risk Opioid Prescribing
Discover the six essential strategies for managing high-risk opioid prescribing, including tapering, replacement therapy, and referral to specialists.
High-dose opioid prescribing is associated with an increased risk of harms, including death.
The six Rs of managing high‑risk opioid prescribing:
- Rotation of opioids
- Reduction (tapering)
- Replacement pharmacotherapy
- Reversal with naloxone
- Referral to allied health practitioners/ other specialists
- Restriction of supply
Opioid taper:
- All opioids (both short- and long-acting) are converted into one long-acting opioid (may involve opioid rotation).
- The dose of the long-acting opioid is decreased at a rate of 10% of the starting dose per week or fortnight.
- The use of short-acting opioids or as-needed doses is strictly limited.
- Non-opioid analgesics are used to manage pain flares.
- Opioid withdrawal symptoms are managed by reducing the taper rate.
In Australia, Pharmaceutical Benefits Scheme (PBS)–subsidised opioid prescriptions rose from 2.4 million in 1992 to 7.5 million in 2012, with associated increases observed in pharmaceutical opioid-related deaths.
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Pain medications (pharmaceutical opioids) are responsible for more deaths and hospitalisations than heroin. Medication use is the most common intervention in healthcare. Refer your patient for an IMM medication review today to ensure your claimants are on the right treatments, supporting their effective recovery and return to health.
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