Dr Melanie Rees-Roberts
DE-eSCALation of opioids post-surgical dischargE - The role of clinical pharmacists in reducing opioid dependence at the interface between hospital and primary care
Opioids are very strong painkillers that are often given to treat severe short-term pain, such as after having surgery. These drugs are very good at short-term pain relief. However, used longer than the recommended 2–4 weeks, they can cause more pain, become addictive and/or lead to death.
Studies in the USA found that taking opioids for longer than a week doubles a person’s risk of using them for more than a year, doubling again if used for over a month. Furthermore, patients receiving high-strength opioids following minor or major surgery were more likely to use them long-term, even if they had never taken this type of medicine before. In addition, poor management of pain medicines (high doses and for long duration) and risk factors such as substance abuse are also thought to contribute to long-term opioid use and addiction. Less is known about opioid prescribing in UK hospitals following surgery and the link with harmful long-term use. However, records show that in 2017-2018, 5.6 million opioid prescriptions were dispensed in the UK, equivalent to approximately 13% of the adult population. Given the risk of long-term use of opioids post-surgery and with over 4.7 million UK surgical procedures occurring every year, preventative action is a focus for providers to minimise long-term opioid use.
This research aims to look at the prescribing trends of opioids and the scale of long-term use following surgery within East Kent and carry out a feasibility study to see:
- if a clinical pharmacist can support patients following surgery to manage their post-surgical pain safely and prevent long-term opioid use
- calculate how much it costs for the NHS
- see how the patients experienced the intervention
For Aim 1, previous records of patients who had surgery from two local hospitals and were discharged on opioids will be reviewed for type and strength of pain-relieving medication prescribed; type of surgery; number of additional opioid prescriptions following discharge; use of medical services (e.g., GP appointments, physiotherapy); and patient demographics.
For Aim 2, to manage and prevent long-term opioid use in recently discharged surgical patients, a clinical pharmacist will carry out an early high-risk medication safety review to ensure that their pain is managed safely.
Lastly, we will collect key data from patients receiving the clinical pharmacist intervention to see how it affected opioid use, costs and healthcare use plus a selection of patients who took part in the study will be invited to participate in an interview asking what they know about opioids and the health risks, and experiences of the intervention.
The project will work together with key stakeholders, such as patients, clinical pharmacists and healthcare professionals to support the running of the project, such as for recruitment, data collection and sharing findings but also help us better understand how the intervention might work over the longer term.
To reach a wider audience the results will be written for NHS websites/newsletters, community magazines, and academic journals.
If you are interested in taking part in the research, you can read our participant information sheet here: Participant Information Leaflet Supporting Safe Use of Opioid Medication after Surgery
Public Involvement partners/group input
Three NIHR Research Champions from KCHFT provided thoughts and insights into the research idea, design and project overall.
Two public contributors will be part of the research team (including a patient with experience of long-term opioid use), joining monthly project meetings and embedding their support and work throughout. The PPIE lead will maintain regular and accessible communication, identify, and address any training needs, and along with the research team, work together with the public contributors.
Examples of activities include reviewing ethics and governance documents, advice and insights into recruitment and delivery of the research activities, preparing lay summaries of the findings, and dissemination activities. Depending on personal preference they could also get involved in patient interviews and data analysis. PPIE activities will be logged to capture all aspects of involvement and demonstrate impact.
We will invite a wider stakeholder group of patients, clinical pharmacists, primary (GPs) and secondary healthcare professionals to share their thoughts of the deprescribing intervention and, if successful, how it could be implemented in the longer term and successfully scaled up.
Funding: NIHR ARC KSS – priorities for care call
Who is involved
- Dr Emma Veale, Medway School of Pharmacy, Principal Investigator
- Dr Johanna Theron, Kent Community Health Foundation Trust, Principal Investigator
- Dr Melanie Rees-Roberts, CHSS, Co-Investigator
- Ellie Santer, CHSS, Co-Investigator
- Dr Julie Hedayioglu, Kent Community Health Foundation Trust, Co-Investigator
- Start date 1/4/2022 End date 30/9/2024