Exploration of GP’s experiences of prescribing opioid medication
Another phase of our opioid prescribing research programme has been completed. This is an interview study examining GPs’ experiences of prescribing opioid medication for chronic pain, paying particular attention to the prescribing of high doses. This is a Pathway to Portfolio study funded through BCUHB. Simon Gill (a BCUHB Primary Care Pharmacist) has been seconded to be Lead Investigator for this project, in collaboration with fellow CFMHAS members Rob Poole, Sadia Nafees and John Bailey.
Abstract
Background: Prescribing of opioid medication has increased over the past 20 years. Most occurs in
primary care for chronic pain. There is little evidence that these drugs are effective for this indication. There are concerns about the continuing prescribing of opioids, particularly in the long term and at high doses.
Aim: To explore GPs’ experiences of prescribing opioids, problems encountered, and factors militating against good prescribing practice.
Design & setting: Qualitative interviews with GPs who prescribe opioids in primary care in North-East
Wales.
Method: Semi-structured interviews with 20 GPs were transcribed and subjected to thematic analysis utilising the framework approach.
Results: Participating GPs identified a range of problems associated with prescribed opioids. They
were concerned about limited effectiveness of the drugs and what they perceived as addiction resulting from their use. They identified healthcare system factors that were obstacles to good prescribing practice such as lack of continuity of care, poor access to secondary care pain management support, and, most importantly, constant time pressure. They reported adverse effects on relationships with patients. Unrealistic expectations that pain could be eliminated resulted in pressure to prescribe stronger drugs and increased doses. It led to difficulties in establishing and maintaining trust and in persuading patients to agree to, and to carry out, dose reductions.
Conclusion: Themes emerging from this study suggest that GPs lack appropriate control of opioid
prescribing. There is a need to develop methods to help patients and GPs to work together to manage chronic pain safely.
How this fits in
Opioid medication is frequently prescribed in primary care but is known to be largely ineffective in
the long-term treatment of chronic pain. This study found that GPs are concerned by this situation
and experience pressures to initiate, continue, or increase opioids against their better judgement.
The factors they identified that make appropriate prescribing difficult to achieve must be addressed if long-term opioid prescribing is to be reduced.
The wider aims of the opioid prescribing research programme are to gain an understanding of the problems, for both patients and doctors, around the prescribing of opioids for chronic pain and to develop and evaluate a package of intervention and resources to facilitate improved management of opioid prescribing in primary care.
Gill, S., Bailey, J., Nafees, S., Poole, R. . A qualitative interview study of GPs’ experiences of prescribing opioid medication for chronic pain. BJGP. 2022. 6(4): BJGPO.2022.0085. DOI: https://doi.org/10.3399/bjgpo.2022.0085
