JMIR Publications

ABSTRACT

Introduction More than 300 million surgical procedures are performed worldwide each year, and opioids remain a primary approach for managing acute postoperative pain. Studies have demonstrated that a significant number of patients do not discontinue opioid treatment and continue to use opioids for months or even years after surgery. Tapering and management of prescription opioids is a well-known practice and is a part of the current clinical guidelines on safe prescribing. Every patient should receive thorough monitoring, education and a tapering plan when prescribed with opioids or receiving refills after a prolonged treatment. There are, however, challenges associated with tapering, including close follow-up, patient education, clinician time, management knowledge level, withdrawal safety and much more. The evolution of follow-up through smartphone applications has shown promising results in some fields of medicine and patients are increasingly interested in the idea of using smartphone applications for follow-up. Materials and Methods The objective of this study is to investigate the efficacy and safety of Prescriby as a tapering intervention in post-operative surgery patients. The efficacy will be measured in tapers successfully completed, doses successfully lowered during tapering, number of “active users”, satisfaction with the intervention and patients successfully remaining off opioid medication at 6 and 12 months after intervention. Participant safety will be monitored by assessing adverse effects during tapering using the Numeric Pain Rating Scale (NPRS) to assess the severity of pain. Participants are recruited via referrals to the Prescriby Clinic from orthopedic clinics and orthopedics departments in the hospital after surgery during the 6 month study period, where they will receive a personalized tapering treatment and follow-up with a clinical pharmacist. Despite the existence of numerous clinical guidelines on tapering off dependence-inducing medications, there is limited knowledge about the outcomes of such tapering. Discussion This study protocol represents a key opportunity to generate new evidence. If the results of the research indicate that significant success has been achieved in tapering off high-risk medications using the applied methodology at the tapering clinic, it creates opportunities for further implementation of similar tapering programs in the Icelandic healthcare settings and beyond Icelandic borders.