Exploring a pharmacist-led, opioid medicines use review post-surgery: A prospective multicentre non-randomised, proof-of-concept study

Background

Opioids are commonly prescribed following surgery, yet prolonged use beyond the post-operative period increases the risk of dependence, adverse events, and persistent opioid use. Recent UK guidance emphasises early review and deprescribing, but practical strategies for implementation remain under-explored. This pragmatic study evaluated the feasibility of a clinical pharmacist-led medicines use review (MUR) to support early opioid de-escalation following surgical discharge in a high prescribing region of the UK.

Methods

A prospective, multicentre, cohort mixed methods feasibility study was conducted across six GP practices in Southeast England. Adults discharged from hospital with opioids (< 120 mg Morphine Milligram Equivalents per day) for acute post-surgical pain were recruited within 10 days of discharge. Participants received a pharmacist-led opioid-focused MUR, to support de-prescribing of opioids post-surgery. Follow-up reviews were conducted until opioids were discontinued or 90 days post-discharge. Outcomes included feasibility of recruitment, intervention delivery, prescribing practices, deprescribing pathways, patient experience, and indicative intervention costs.

Results

Twenty-three patients consented (mean age 60 years; 45.5% male). At baseline, 22.7% had already stopped opioids, while the majority (77.3%) engaged in deprescribing: 40.9% on rapid tapering, 27.3% gradual tapering, and 4.5% continuation at this first assessment. All patients discontinued opioid use within 31 days. Opioid prescribing at discharge was variable, with most receiving immediate-release formulations, though a minority were prescribed multiple opioids concurrently and one patient prolonged-release oxycodone, contrary to national guidance. Reported pain decreased over time, and quality-of-life scores showed modest improvements. Pharmacists delivered the intervention with minimal additional support, and patient satisfaction surveys indicated high acceptability. Recruitment was challenging due to difficulties identifying eligible patients in GP records and workforce capacity constraints.

Conclusions

Pharmacist-led MURs to support opioid deprescribing post-surgery are feasible, acceptable to patients, and deliverable at modest cost within primary care. However, variability in discharge prescribing, challenges in timely patient identification, and workforce pressures limit scalability. Larger, adequately powered studies are required to establish clinical and cost-effectiveness, develop risk stratification tools, and explore system-level strategies for integration into routine post-operative care.

Trial Registration:

ClinicalTrials.gov, reference number: NCT06396663; retrospectively registered. Accessible at: https://clinicaltrials.gov/study/NCT06396663