Opioids, such as oxycodone, morphine, codeine, tramadol and fentanyl, are commonly prescribed to manage pain. You might be given a prescription when experiencing pain, or after surgery or an injury.

But while opioids may relieve pain in the short term, they provide little to no lasting improvement in pain or function beyond a few weeks for people whose pain isn’t caused by cancer.

Opioids can also cause side effects such as nausea, constipation and drowsiness, as well as serious risks such as dependence and overdose.

Over the past decade, Australia has introduced initiatives to reduce opioid use and related harm. This includes new guidelines that recommend reducing the dose or stopping opioids when the risks of continuing outweigh the benefits.

Many people can reduce or stop opioids without their pain worsening. Some people even experience less pain. However, for some people, reducing or stopping opioids can result in worse pain, mental health crises and even suicide.

Our new research, published today in the New England Journal of Medicine, explains how to safely reduce and stop taking prescription opioids.

How do you know when it’s time to stop? Then what?

Determining whether it is appropriate to reduce or stop opioids depends on several factors unique to each person. These include:

• why opioids were prescribed
• how long they’ve been used
• what other treatments you’ve tried
• how the medication affects your pain, function and quality of life
• your life circumstances.

If it’s appropriate to trial reducing or stopping opioids, guidelines from Australia, the United Kingdom and the United States emphasise the following principles:

1) Shared decision-making

Shared decision-making is where health-care professionals and patients work together to set goals, weigh risks and benefits, and make informed choices.

This means collaboratively designing an opioid reduction plan that reflects the person’s needs, preferences and circumstances, rather than imposing a one-size-fits-all approach.

Research shows shared decision-making may lead to better outcomes, and patients value this process.

2) Reduce gradually

Stopping opioids suddenly can cause withdrawal symptoms such as anxiety, insomnia, and stomach upset. Rapid dose reductions can also increase the risk of overdose, mental distress and suicide.

To avoid these risks, opioids should be reduced gradually over weeks, months or even longer. The process should be flexible, allowing for pauses or adjustments to the reduction plan if needed.

When someone takes lower doses of opioids over time, their body’s tolerance decreases. If they return to a higher dose, there is a risk of overdose. For this reason, health-care professionals may recommend having naloxone available. This is a medication that can reverse an opioid overdose.

3) Set up other supports

Supportive strategies should be used before, during and after reducing opioids. These can include:

• physical therapies such as physiotherapy
• psychological approaches such as mindfulness
• non-opioid medications
• mental health support from health-care professionals, friends and family
• education about pain self-management.

The evidence supporting specific interventions is often limited or uncertain. Choosing a strategy will depend on your individual preferences and access. The best approach is likely a combination of several different supports.

4) See your health-care provider for ongoing monitoring

Regular monitoring from a health-care professional is recommended during and after opioid reduction to assess pain, function, withdrawal symptoms and wellbeing.

This can help to ensure that any issues are identified early and are addressed.

If someone experiences a clear decline in their quality of life, for example, it may be necessary to pause or stop the taper and revisit it later, provide extra supports or implement strategies to manage withdrawal symptoms.

We need a health system that supports this process

Making opioid reduction safer and more effective requires putting these principles into practice. But many patients and health-care professionals still face challenges when doing so.

It’s best practice to access a team-based pain management program with support from a doctor, physiotherapist and psychologist, among other providers, to manage pain and reduce the use of opioids. But access to these services remains limited in many parts of Australia.

Consumer organisations and professional bodies have called for greater access to team-based pain services so more people, especially those living in rural and under-served areas, can access support.

Australian health-care professionals have also requested more education and training in pain management, prescribing and opioid reduction, as well as stronger evidence about what works, for whom and why. This is so they’re better able to tailor their care to each person’s needs.

Other strategies such as reducing the amount of opioids prescribed – including after surgery – have also been proposed to help prevent long-term opioid use and the need for reduction plans later on.

Aili Langford, Pharmacist, Lecturer, NHMRC Emerging Leadership Fellow, Sydney Pharmacy School, The University of Sydney, University of Sydney and Christine Lin, Professor, Institute for Musculoskeletal Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

As we enter the colder months in Australia, COVID is making headlines again, this time due to the emergence of a new variant: NB.1.8.1.

Last week, the World Health Organization designated NB.1.8.1 as a “variant under monitoring”, owing to its growing global spread and some notable characteristics which could set it apart from earlier variants.

So what do you need to know about this new variant?

The current COVID situation

More than five years since COVID was initially declared a pandemic, we’re still experiencing regular waves of infections.

It’s more difficult to track the occurrence of the virus nowadays, as fewer people are testing and reporting infections. But available data suggests in late May 2025, case numbers in Australia were ticking upwards.

Genomic sequencing has confirmed NB.1.8.1 is among the circulating strains in Australia, and generally increasing. Of cases sequenced up to May 6 across Australia, NB.1.8.1 ranged from less than 10% in South Australia to more than 40% in Victoria.

Wastewater surveillance in Western Australia has determined NB.1.8.1 is now the dominant variant in wastewater samples collected in Perth.

Internationally NB.1.8.1 is also growing. By late April 2025, it comprised roughly 10.7% of all submitted sequences – up from just 2.5% four weeks prior. While the absolute number of cases sequenced was still modest, this consistent upward trend has prompted closer monitoring by international public health agencies.

NB.1.8.1 has been spreading particularly in Asia – it was the dominant variant in Hong Kong and China at the end of April.

Where does this variant come from?

According to the WHO, NB.1.8.1 was first detected from samples collected in January 2025.

It’s a sublineage of the Omicron variant, descending from the recombinant XDV lineage. “Recombinant” is where a new variant arises from the genetic mixing of two or more existing variants.

The image to the right shows more specifically how NB.1.8.1 came about.

What does the research say?

Like its predecessors, NB.1.8.1 carries a suite of mutations in the spike protein. This is the protein on the surface of the virus that allows it to infect us – specifically via the ACE2 receptors, a “doorway” to our cells.

The mutations include T22N, F59S, G184S, A435S, V445H, and T478I. It’s early days for this variant, so we don’t have much data on what these changes mean yet. But a recent preprint (a study that has not yet been peer reviewed) offers some clues about why NB.1.8.1 may be gathering traction.

Using lab-based models, researchers found NB.1.8.1 had the strongest binding affinity to the human ACE2 receptor of several variants tested – suggesting it may infect cells more efficiently than earlier strains.

The study also looked at how well antibodies from vaccinated or previously infected people could neutralise or “block” the variant. Results showed the neutralising response of antibodies was around 1.5 times lower to NB.1.8.1 compared to another recent variant, LP.8.1.1.

This means it’s possible a person infected with NB.1.8.1 may be more likely to pass the virus on to someone else, compared to earlier variants.

What are the symptoms?

The evidence so far suggests NB.1.8.1 may spread more easily and may partially sidestep immunity from prior infections or vaccination. These factors could explain its rise in sequencing data.

But importantly, the WHO has not yet observed any evidence it causes more severe disease compared to other variants.

Reports suggest symptoms of NB.1.8.1 should align closely with other Omicron subvariants.

Common symptoms include sore throat, fatigue, fever, mild cough, muscle aches and nasal congestion. Gastrointestinal symptoms may also occur in some cases.

How about the vaccine?

There’s potential for this variant to play a significant role in Australia’s winter respiratory season. Public health responses remain focused on close monitoring, continued genomic sequencing, and promoting the uptake of updated COVID boosters.

Even if neutralising antibody levels are modestly reduced against NB.1.8.1, the WHO has noted current COVID vaccines should still protect against severe disease with this variant.

The most recent booster available in Australia and many other countries targets JN.1, from which NB.1.8.1 is descended. So it makes sense it should still offer good protection.

Ahead of winter and with a new variant on the scene, now may be a good time to consider another COVID booster if you’re eligible. For some people, particularly those who are medically vulnerable, COVID can still be a serious disease.

Lara Herrero, Associate Professor and Research Leader in Virology and Infectious Disease, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.