Interventions to safely and effectively reduce (taper) use of opioids in chronic non-cancer pain: a systematic review
Health Technol Assess. 2026 Mar;30(27):1-249. doi: 10.3310/GDWP3572.
ABSTRACT
BACKGROUND: Opioids are prescribed for the management of chronic non-cancer pain, but they have important limitations and evidence does not support long-term use. People taking opioids therefore need support to reduce or stop use.
OBJECTIVES: The research aimed to inform better practice, pathways and service design to support people to reduce or stop their use of opioids and address inequalities. Our objectives were to evaluate evidence on: effectiveness, safety (including adverse effects, adverse event) and acceptability of interventions to reduce opioid use barriers and facilitators to effective intervention inequalities in access to, acceptability of and benefiting from interventions.
METHODS: We undertook four systematic reviews of published evidence on effectiveness; safety and acceptability; barriers and facilitators and inequalities. Searches included databases [MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycInfo® (American Psychological Association, Washington, DC, USA)], trial registries (EU-CTR, International Standard Randomised Controlled Trial Number, Australian New Zealand Clinical Trials Register, ClinicalTrials.gov), websites (National Institute for Health and Care Research - be part of research, National Institute for Health and Care Excellence Evidence Search, Health Management Information Consortium, British Pain Society Members area) and repositories (Google Scholar, CORE.ac.uk) up to September 2022. Records were independently assessed for inclusion using prespecified criteria: (1) adults with chronic non-cancer pain, with (2) prescription opioid use of at least 3 months experiencing an (3) intervention aiming reduce or discontinue the use of opioids. Cochrane Risk-of-Bias tool for randomised controlled trials and the appropriate Critical Appraisal Skills Programme tool were used for cohort, case-control and qualitative studies. For the reviews of effectiveness and safety, data were synthesised and presented using tables and narrative synthesis. Meta-analysis was not appropriate. The barriers and facilitators review used thematic synthesis.
RESULTS: A total of 44 studies (reported across 52 papers) were included in at least 1 of the reviews: 27 studies were included in the effectiveness, 7 in safety and 16 in the barriers and facilitators reviews. All but two studies provided evidence for the inequalities review. The characteristics of the included studies were heterogeneous with different intervention approaches examined. Fifteen studies reported effects on pain. There was no difference in pain severity between intervention and control groups across seven of eight comparative studies. All but two studies reported change in opioid use. The proportion of patients who ceased opioid use varied across studies and some studies reported evidence of later relapse. Other outcomes, including anxiety and depression and sleep quality, were examined across the included studies but there was no clear pattern of effect. No adverse event studies reported serious adverse event and no participants reportedly withdrew due to adverse event. Few studies examined intervention acceptability.
BARRIERS AND FACILITATORS: Eight barriers and eight facilitators were identified. They highlight the complex nature of the tapering process with the potential for multiple interdependent, behavioural, structural and contextual barriers to arise.
INEQUALITIES: Most studies reported on PROGnosis RESearch Strategy partnership-Plus categories, but few considered impact. Our findings suggest males and older patients experience poorer tapering outcomes.
CONCLUSIONS: Evidence to support any specific opioid tapered reduction intervention is mixed and uncertain. Our findings reinforce that service design and delivery require careful consideration of individual-level factors and highlight the potential to widen inequalities. Stakeholders consulted on the evidence suggest valuing relationships, addressing fear and stigma and upskilling in behaviour change techniques are key.
STUDY REGISTRATION: This study is registered as PROSPERO CRD42020171135.
FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128842) and is published in full in Health Technology Assessment; Vol. 30, No. 27. See the NIHR Funding and Awards website for further award information.
PMID:41912441 | DOI:10.3310/GDWP3572