High dose opioid (morphine like) medications prescribed to patients with non-cancer pain is increasing. Concern about the risks and weak evidence for prescribing long term opioid medications is rising.
Many patients want to reduce their dependence on opioids but feel constrained by fear of more pain and experiencing withdrawal symptoms when the dose is reduced. Currently there are few guidelines on reducing or ceasing high dose opioids. The purpose of this project is to study two pathways to reduce or cease high dose opioid use in patients with non-cancer pain:
1. Infusions of low doses of ketamine (an anaesthetic drug) under the skin over five days in hospital while the patients’ opioid medications are stopped. The ketamine prevents withdrawal symptoms and helps with pain.
2. Slowly tapering high dose opioids in outpatient clinics, and using other medications to help manage pain and withdrawal symptoms.
Collaborators: South Eastern Sydney Local Health District, Prince of Wales Hospital (Pain Management Service), Agency for Clinical Innovation (Pain Management Network), Australian Health Services Research Institute