Background/Purpose: With the evolution of disease modifying anti-rheumatic drugs medications, the need for opioids in the treatment of rheumatic diseases has decreased. However, rheumatology professionals are often presented with patients in whom chronic opioid therapy was started prior to the availability of newer DMARDs and may require reductions in opioid doses. Current guidelines suggest opioid tapering should be considered in patients with chronic noncancer pain on ≥90 mg morphine equivalent daily dose (MEDD) daily or in combination with other high-risk medications.

Methods: The pharmacy team developed a three phased program starting in June 2019 including provider/staff education, updates to workflows, and implementation of individualized patient taper plans. Patients identified by providers are enrolled in the pharmacy service. The pharmacy team serves as a continuous resource to providers and works directly with patients enrolled in the service. Baseline characteristics, historical data on opioid related efficacy/side effects, and daily morphine equivalents are collected/tracked for each patient.

Results: Provider and staff education sessions led by the pharmacy team occurred in June 2019, October 2019 and December 2019. Controlled substance contract workflow changes were implemented in December 2019. The number of signed contracts reportable at baseline was 0. To date, a total of 253 signed controlled substance contracts (including tramadol and pregabalin) are documented in TCFR electronic health record. As of April 2021, a total of 124 patients have active prescriptions (defined as a refill in the last 3 months) for opioids including codeine, hydrocodone, oxycodone, methadone, and morphine. Since implementation of our program, 6, 33, and 10 patients have discontinued opioids prescribed by TCFR providers in the years 2019, 2020, and 2021. A total of 19 patients have been enrolled in the pharmacist-led opioid taper service. All patients are co-managed by the pharmacist and the provider. Daily initial starting doses ranged from 20 to 200 MEDD. A total of 5 patients (26%) have successfully tapered off opioids. Nine patients (47%) have had reductions in MEDD. Five patients (26%) have remained on the same initial dose. A total of 9 patients enrolled in the service had an MEDD ≥ 90. Of those patients, 56% reduced MEDD ≤90, of which 2 patients are no longer on opioids. The average MEDD percent reduction for all patients enrolled in the service was 48%. The average duration of all patients enrolled with the service is 11 months with a range from 5-20 months. The duration of taper for patients who have successfully tapered off opioids ranged from 1 to 3 months.

Conclusion: Successful opioid tapering is a time intensive process and requires a multidisciplinary approach. This provides an opportunity for pharmacists to play an essential role as part of a team-based approach to ensure a successful opioid taper or discontinuation while minimizing adverse events.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pharmacist-led-multidisciplinary-approach-to-opioid-tapering-in-a-private-rheumatology-practice-patient-outcomes/