{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:14:34Z","timestamp":1789661674609,"version":"4.0.1"},"reference-count":60,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,6,25]],"date-time":"2023-06-25T00:00:00Z","timestamp":1687651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Journal of Australia"],"published-print":{"date-parts":[[2023,7,17]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Long term opioids are commonly prescribed to manage pain. Dose reduction or discontinuation (deprescribing) can be challenging, even when the potential harms of continuation outweigh the perceived benefits. The <jats:italic>Evidence\u2010based clinical practice guideline for deprescribing opioid analgesics<\/jats:italic> was developed using robust guideline development processes and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, and contains deprescribing recommendations for adults prescribed opioids for pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main recommendations<\/jats:title><jats:p>Eleven recommendations provide advice about when, how and for whom opioid deprescribing should be considered, while noting the need to consider each person's goals, values and preferences. The recommendations aim to achieve:\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>implementation of a deprescribing plan at the point of opioid initiation;<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>initiation of opioid deprescribing for persons with chronic non\u2010cancer or chronic cancer\u2010survivor pain if there is a lack of overall and clinically meaningful improvement in function, quality of life or pain, a lack of progress towards meeting agreed therapeutic goals, or the person is experiencing serious or intolerable opioid\u2010related adverse effects;<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>gradual and individualised deprescribing, with regular monitoring and review;<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>consideration of opioid deprescribing for individuals at high risk of opioid\u2010related harms;<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>avoidance of opioid deprescribing for persons nearing the end of life unless clinically indicated;<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>avoidance of opioid deprescribing for persons with a severe opioid use disorder, with the initiation of evidence\u2010based care, such as medication\u2010assisted treatment of opioid use disorder; and<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>use of evidence\u2010based co\u2010interventions to facilitate deprescribing, including interdisciplinary, multidisciplinary or multimodal care.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>Changes in management as a result of these guidelines<\/jats:title><jats:p>To our knowledge, these are the first evidence\u2010based guidelines for opioid deprescribing. The recommendations intend to facilitate safe and effective deprescribing to improve the quality of care for persons taking opioids for pain.<\/jats:p><\/jats:sec>","DOI":"10.5694\/mja2.52002","type":"journal-article","created":{"date-parts":[[2023,6,25]],"date-time":"2023-06-25T14:02:51Z","timestamp":1687701771000},"page":"80-89","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":64,"title":["Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations"],"prefix":"10.5694","volume":"219","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0509-5136","authenticated-orcid":false,"given":"Aili V","family":"Langford","sequence":"first","affiliation":[{"name":"Centre for Medicine Use and Safety Monash University  Melbourne VIC"},{"name":"University of Sydney  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine CW","family":"Lin","sequence":"additional","affiliation":[{"name":"Institute for Musculoskeletal Health University of Sydney  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Bero","sequence":"additional","affiliation":[{"name":"Center for Bioethics and Humanities University of Colorado  Aurora (CO) USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona M","family":"Blyth","sequence":"additional","affiliation":[{"name":"University of Sydney  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Doctor","sequence":"additional","affiliation":[{"name":"University of Southern California  Los Angeles (CA) USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Holliday","sequence":"additional","affiliation":[{"name":"University of Newcastle  Newcastle NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun\u2010Hee","family":"Jeon","sequence":"additional","affiliation":[{"name":"University of Sydney  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Moullin","sequence":"additional","affiliation":[{"name":"Curtin University  Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bridin","family":"Murnion","sequence":"additional","affiliation":[{"name":"University of Sydney  Sydney NSW"},{"name":"Western Sydney Local Health District  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5341-1055","authenticated-orcid":false,"given":"Suzanne","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Monash Addiction Research Centre Monash University  Melbourne VIC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rawa","family":"Osman","sequence":"additional","affiliation":[{"name":"NPS MedicineWise  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Penm","sequence":"additional","affiliation":[{"name":"University of Sydney  Sydney NSW"},{"name":"Prince of Wales Hospital and Community Health Services  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Reeve","sequence":"additional","affiliation":[{"name":"Centre for Medicine Use and Safety Monash University  Melbourne VIC"},{"name":"University of South Australia  Adelaide SA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0859-5614","authenticated-orcid":false,"given":"Sharon","family":"Reid","sequence":"additional","affiliation":[{"name":"University of Sydney  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Wale","sequence":"additional","affiliation":[{"name":"Melbourne VIC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl R","family":"Schneider","sequence":"additional","affiliation":[{"name":"University of Sydney  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danijela","family":"Gnjidic","sequence":"additional","affiliation":[{"name":"University of Sydney  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,6,25]]},"reference":[{"key":"e_1_2_12_1_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30925-9"},{"key":"e_1_2_12_2_1","volume-title":"Chronic pain in Australia [Cat. No. PHE 267]","author":"Australian Institute of Health and Welfare","year":"2020"},{"key":"e_1_2_12_3_1","volume-title":"Addressing problematic opioid use in OECD countries","author":"Organisation for Economic Co\u2010operation and Development","year":"2019"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.13792"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/pme.12820"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-022-01783-y"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.18472"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.0899"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2004.09.019"},{"key":"e_1_2_12_10_1","unstructured":"World Health Organization.Medication without harm \u2014 WHO Global Patient Safety Challenge. WHO 2017.https:\/\/www.who.int\/publications\/i\/item\/WHO\u2010HIS\u2010SDS\u20102017.6(viewed Mar 2023)."},{"key":"e_1_2_12_11_1","unstructured":"Australian Commission on Safety and Quality in Health Care.Medication without harm \u2014 WHO Global Patient Safety Challenge: Australia's response. ACSQHC 2020.https:\/\/www.safetyandquality.gov.au\/publications\u2010and\u2010resources\/resource\u2010library\/medication\u2010without\u2010harm\u2010who\u2010global\u2010patient\u2010safety\u2010challenge\u2010australias\u2010response(viewed Mar 2022)."},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2020-010881"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12732"},{"key":"e_1_2_12_14_1","volume-title":"Pain and Analgesia","author":"Therapeutic Guidelines","year":"2021"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.11013"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m283"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0161248"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.090449"},{"key":"e_1_2_12_19_1","unstructured":"National Health and Medical Research Council.Guidelines for guidelines handbook.https:\/\/www.nhmrc.gov.au\/guidelinesforguidelines(viewed Sept 2022)."},{"key":"e_1_2_12_20_1","unstructured":"National Health and Medical Research Council.Procedures and requirements for meeting the 2011 NHMRC standard for clinical practice guidelines [May 2011 version 1.1.]https:\/\/www.nhmrc.gov.au\/sites\/default\/files\/documents\/reports\/clinical%20guidelines\/meeting\u2010clinical\u2010practice\u2010guidelines.pdf(viewed June 2022)."},{"key":"e_1_2_12_21_1","volume-title":"Evidence\u2010based clinical practice guideline for deprescribing opioid analgesics: administrative report","author":"Langford AV","year":"2022"},{"key":"e_1_2_12_22_1","volume-title":"Evidence\u2010based clinical practice guideline for deprescribing opioid analgesics: technical report","author":"Langford AV","year":"2022"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000002270"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcpt.13844"},{"key":"e_1_2_12_25_1","volume-title":"GRADE handbook [updated Oct 2013]","author":"Sch\u00fcnemann H","year":"2013"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.02.003"},{"key":"e_1_2_12_27_1","volume-title":"Communication techniques for opioid analgesic tapering conversations","author":"Langford AV","year":"2020"},{"key":"e_1_2_12_28_1","volume-title":"Evidence\u2010based clinical practice guideline for deprescribing opioid analgesics","author":"Langford AV","year":"2022"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.190144"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-016-3810-3"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6610a1"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2019.1692122"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.7326\/M17-0598"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pny231"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-020-06253-8"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0035798"},{"key":"e_1_2_12_37_1","first-page":"836","article-title":"Does integrative medicine reduce prescribed opioid use for chronic pain?","volume":"21","author":"Hassan S","year":"2020","journal-title":"A systematic literature review. Pain Med"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S186662"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-020-01368-y"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2020.11.002"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.68.5206"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.13605"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2011.01134.x"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2019-000483"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/pme.12773"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.170958"},{"key":"e_1_2_12_47_1","volume-title":"National guidelines for medication\u2010assisted treatment of opioid dependence","author":"Gowing L","year":"2014"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000166"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.1464"},{"key":"e_1_2_12_50_1","first-page":"CD011117","article-title":"Opioid agonist treatment for pharmaceutical opioid dependent people","volume":"5","author":"Nielsen S","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1093\/braincomms\/fcz025"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000002298"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2019.05.001"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpt.13114"},{"key":"e_1_2_12_55_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pny320"},{"key":"e_1_2_12_56_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pny228"},{"key":"e_1_2_12_57_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2019.5233"},{"key":"e_1_2_12_58_1","doi-asserted-by":"publisher","DOI":"10.1038\/npp.2017.51"},{"key":"e_1_2_12_59_1","doi-asserted-by":"publisher","DOI":"10.1111\/ner.13051"},{"key":"e_1_2_12_60_1","volume-title":"Evidence\u2010based clinical practice guideline for deprescribing opioid analgesics: treatment algorithm","author":"Langford AV","year":"2022"}],"container-title":["Medical Journal of Australia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.5694\/mja2.52002","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T07:41:46Z","timestamp":1692258106000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.5694\/mja2.52002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,25]]},"references-count":60,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,7,17]]}},"alternative-id":["10.5694\/mja2.52002"],"URL":"https:\/\/doi.org\/10.5694\/mja2.52002","archive":["Portico"],"relation":{},"ISSN":["0025-729X","1326-5377"],"issn-type":[{"value":"0025-729X","type":"print"},{"value":"1326-5377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,25]]},"assertion":[{"value":"2023-01-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}