FRACGP, Addiction Medicine Registrar, Turning Point, Eastern Health, Vic.
MBBS (Hons), MSc, MPsychiatry, PhD, FRANZCP, Addiction Psychiatrist, Clinical Lead, Turning Point, Eastern Health, Vic; Senior Lecturer, Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Vic.
Aust J Gen Pract. 2020 Mar;49(3):116-120. doi: 10.31128/AJGP-06-19-4967.
High-dose opioid prescribing is associated with an increased risk of harms, including death.
The aim of this article is to discuss the concept of high-risk opioid prescribing, as well as relevant management strategies for patients on >100 mg oral morphine equivalent daily dose (OMEDD). The six 'Rs' approach to managing high-risk opioid prescribing (Rotation of opioids; Reduction; Replacement pharmacotherapy; Reversal with naloxone; Referral; Restriction of supply) is discussed.
The six Rs is an aide-memoire that summarises the management options available to mitigate the risk of high OMEDDs. However, an effective therapeutic alliance between clinician and patient remains the foundation of all risk mitigation strategies.
高剂量阿片类药物处方与危害风险增加相关，包括死亡。
本文旨在讨论高风险阿片类药物处方的概念，以及 >100 毫克口服吗啡等效日剂量（OMEDD）患者的相关管理策略。讨论了管理高风险阿片类药物处方的“六个 R”方法（阿片类药物转换；减少；替代药物治疗；纳洛酮逆转；转介；供应限制）。
六个 R 是一个助记符，总结了减轻高 OMEDD 风险的可用管理选项。然而，临床医生和患者之间的有效治疗联盟仍然是所有风险缓解策略的基础。
