Reducing opioid errors
March 30, 2012
FLAWS in the current method of
rotating opioids are contributing to
a growing number of opioidrelated
fatalities in the US,
according new research.
Published in Pain Medicine, the
research included the results from
a scientific literature review,
Review and Critique of Opioid
Rotation Practices and Associated
Risks of Toxicity, and a case study,
Overdose Deaths Demand a New
Paradigm for Opioid Rotation.
The research found that
common practices for changing
from one opioid to another, may
be contributing to growing
mortality rates from overdose in
the US, with recent figures showing
around 15,000 die from opioid
overdose across America per annum.
According to the research, flaws
in the rotation of opioids, including
prescriber error and the use of
inaccurate dose conversion ratios
found in published protocols, are
contributing to this growth.
To this end, the researchers
suggested that when rotating
opioids that the original opioid be
reduced by 10%-30%, whilst the
new opioid is begun at the lowest
available dose.
The researchers then suggested
that the original opioid dose then
be reduced by 10% to 25% per
week while increasing the dose of
the new daily opioid dose by 10%
to 20% (based upon clinical need
and safety).
Lastly, the researchers said that
healthcare professionals should
provide sufficient immediaterelease
opioid throughout the
rotation to prevent withdrawal and
keep pain levels down so the
patient is not tempted to take too
much medication.
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