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Opioid Deprescribing — RACP Adult Medicine MCQ

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HardNeurologyOpioid DeprescribingRACP Adult Medicine

A 55-year-old with nonspecific chronic low-back pain has taken oxycodone 60 mg daily for three years. Function and pain have not improved with dose escalation, and he now has constipation and sleep-disordered breathing. There is no acute psychiatric crisis or aberrant drug use. What is the best management plan?

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Reveal the answer and explanation

Correct answer: A — Agree a gradual oxycodone taper integrated with rehabilitation, psychological care and non-opioid analgesia

Explanation lettering: D = shown as A · A = shown as B · B = shown as D

D is correct. Persistent lack of functional benefit plus opioid-related harm is a reason to renegotiate treatment goals and undertake a collaborative, gradual taper integrated with multimodal pain care. E risks withdrawal, distress and disengagement; abrupt cessation is reserved for exceptional immediate danger. A introduces a complex long-acting opioid with conversion and QT risks without correcting ineffective opioid-centred care. B compounds dose-dependent harm despite treatment failure. C adds sedation and respiratory risk without a demonstrated neuropathic indication. The taper rate is individualised, may pause if clinically necessary and should include treatment of withdrawal, sleep, mood and functional goals rather than a punitive fixed schedule.

Reference: ANZCA PS01(PM): Opioid analgesics in chronic non-cancer pain: https://www.anzca.edu.au/getattachment/7d7d2619-6736-4d8e-876e-6f9b2b45c435/PS01%28PM%29-Statement-regarding-the-use-of-opioid-analgesics-in-patients-with-chronic-non-cancer-pain