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Inappropriate opioid prescribing practices: A narrative review
Brian Kim1, Seonaid Nolan2, Tara Beaulieu3
1Department of Medicine, University of British Columbia, Vancouver, Canada, and St. Paul's Hospital, Vancouver, Canada.
Summary
Identifying inappropriate opioid prescribing is crucial to prevent harms like overdose. Key indicators include high doses, concurrent benzodiazepine use, and geriatric-specific factors, informing safer practices.
Area of Science:
- Pharmacology
- Public Health
- Clinical Medicine
Background:
- Opioid-related harms, including overdose and mortality, are significant public health concerns.
- Inappropriate opioid prescribing practices contribute to these harms.
- Clear definitions and indicators for inappropriate opioid prescribing are lacking.
Purpose of the Study:
- To identify and synthesize indicators of inappropriate opioid prescribing through a comprehensive literature review.
- To inform healthcare providers on recognizing and avoiding high-risk prescribing patterns.
Main Methods:
- A systematic literature review was conducted across five electronic databases.
- Search terms included "opioid," "analgesics," "inappropriate prescribing," "practice patterns," and "prescription drug misuse."
- Gray literature and reference lists were also searched, yielding 41 studies for analysis from 4,665 initial articles.
Main Results:
- High-daily-dose opioid prescriptions were identified in 14 studies.
- Coadministration of benzodiazepines and opioids was noted in 14 studies.
- Inappropriate prescribing in geriatric populations (10 studies), patient-specific factors (8 studies), wrong indication (4 studies), and initiating long-acting opioids in opioid-naive patients (4 studies) were also identified.
Conclusions:
- Key indicators of inappropriate opioid prescribing include high daily doses, concurrent benzodiazepine use, and geriatric-specific considerations.
- Recognizing these indicators is vital for mitigating opioid-related harms.
- This information can guide improvements in clinical opioid prescribing practices.
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