The six Rs of managing high‑risk opioid prescribing

Updated: Jun 8, 2023

High-dose opioid prescribing is associated with an increased risk of harms, including death.

Box 1. The six Rs of managing high‑risk opioid prescribing

• Rotation of opioids

• Reduction (tapering)

• Replacement pharmacotherapy

• Reversal with naloxone

• Referral to allied health practitioners/ other specialists

• Restriction of supply

Box 2. Opioid taper

• All opioids (both short- and long-acting) are converted into one long-acting opioid (may involve opioid rotation).

• The dose of the long-acting opioid is decreased at a rate of 10% of the starting dose per week or fortnight.

• The use of short-acting opioids or as-needed doses is strictly limited.

• Non-opioid analgesics are used to manage pain flares.

• Opioid withdrawal symptoms are managed by reducing the taper rate.