Barriers and motivators for opioid deprescribing among Danish adults receiving long-term treatment with short-acting opioids: an exploratory qualitative study in primary care informed by self-determination theory.
Practitioners should recognize that tapering opioids is not just a technical task but involves relational dynamics and addressing patient ambivalence.
Where it sits
this study against the rest of the slu-pp-332 (exercise mimetic) corpusSummary and findings
This study explored barriers and motivators for opioid deprescribing among Danish adults receiving long-term treatment with short-acting opioids. Eleven participants, with a mean age of 62 years, were interviewed to understand their experiences and motivations regarding medication change. The findings emphasize the relational aspects of tapering and the importance of addressing ambivalence in clinical practice.
Abstract
<h4>Background</h4>Long-term opioid treatment for chronic non-cancer pain (CNCP) yields limited benefit and notable risk of harm. Danish guidelines discourage long-term treatment with short-acting opioids, yet short-acting opioid prescribing persists.<h4>Aim</h4>To investigate the barriers and motivators to opioid deprescribing among adults with CNCP, receiving long-term treatment with short-acting opioids in primary care.<h4>Methods</h4>We conducted an explorative qualitative study using semi-structured, face-to-face interviews with adults with CNCP with long-term treatment with short-acting opioids invited through Danish primary care. The analysis was abductive inspired by reflexive thematic analysis using inductive coding and theme generation, followed by interpretation through the self-determination theory.<h4>Results</h4>11 participants were interviewed (mean age of 62 years; eight women). Three themes were generated: (1) Effects and consequences, (2) Significant relationships, and (3) The work of identity. Participants experienced that as-needed dosing with short-acting opioid provided psychological reassurance that could enable tapering engagement. In line with self-determination theory, we found that the motivational quality towards medication change varied with the degree to which the needs for: autonomy, competence, and relatedness were satisfied. Attentive and respectful care fostered identified or integrated regulation, whereas suspicion promoted controlled motivation or amotivation. Ambivalence made tapering simultaneously desirable and untenable.<h4>Conclusions</h4>Sustainable opioid reductions among adults with CNCP who use short-acting opioids long-term is not merely a technical exercise. It is inherently relational and attentive to identity. Clinical practice could beneficially address ambivalence explicitly, rather than treating it as resistance, leverage short-acting opioid flexibility as reassurance, and support autonomy, competence, and relatedness.
Background
The paper addresses the ongoing issue of long-term opioid treatment for chronic non-cancer pain (CNCP), which is associated with limited benefits and significant risks. Previous guidelines in Denmark discourage such practices, yet short-acting opioid prescriptions continue. Understanding the barriers and motivators for deprescribing is crucial for improving patient outcomes and aligning with clinical guidelines.
Methods
This exploratory qualitative study involved semi-structured, face-to-face interviews with adults diagnosed with CNCP who were receiving long-term treatment with short-acting opioids. Participants were invited through Danish primary care services. The analysis utilized reflexive thematic analysis, focusing on inductive coding and theme generation.
Results
The study identified three main themes: (1) Effects and consequences, (2) Significant relationships, and (3) The work of identity. Participants reported that as-needed dosing provided psychological reassurance, which facilitated engagement in tapering. The motivational quality towards medication change was influenced by the satisfaction of needs for autonomy, competence, and relatedness.
Interpretation
The findings highlight the relational and psychological aspects of opioid deprescribing, contrasting with previous literature that often emphasizes technical or pharmacological approaches. While the study provides insights into patient motivations, the small sample size and qualitative nature limit the ability to generalize results. The implications for clinical practice suggest a need for a more nuanced approach to addressing ambivalence and fostering patient autonomy.
Key findings
- 11 participants interviewed, mean age 62 years, n=11.
- Eight women participated in the study.
Limitations
- Qualitative study with small sample size, n=11.
- Findings based on subjective experiences, limiting generalizability.
- No quantitative measures reported.