A qualitative interview study of GPs' experiences of prescribing opioid medication for chronic pain.

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.