The constant conflicts of opioid prescribing–GPs’ views on treating chronic pain with opioids in primary care: a reflexive qualitative analysis

Background: Despite limited evidence supporting the long-term effectiveness of opioid therapy and existing recommendations on multi-disciplinary treatment, patients with chronic non-cancer pain (CNCP) continue to receive opioids. In Sweden, most prescription renewals for CNCP are issued by general practitioners (GPs). Aim: To explore GPs’ experiences with and understanding of opioid prescribing for CNCP and their views on multi-disciplinary collaboration. Methods: Semi-structured interviews were conducted with GPs and one GP-trainee in Region Uppsala, Sweden (February–June 2022). Topics included long-term opioid treatment (LTOT), opioid tapering, prescription renewal and multi-disciplinary collaboration. The interviews were recorded, transcribed and thematically analyzed. Results: Twelve participants including one GP trainee with a mean experience of 13 years were involved. Two main themes were developed. (1) To endure the ethical conflicts of opioid prescribing practices, where the GPs negotiated ethical conflicts arising in the intersection between patient needs, personal values and clinical guidelines regarding LTOT. (2) The last resort, where the GP’s role was conceptualized through the lens of systemic healthcare structures, perceived patient demands, expectations from fellow healthcare providers and the internal expectations held by themselves. Conclusions: GPs experienced moral distress prescribing opioids and reinforced stigma toward patients with CNCP and LTOT. These dynamics hinder treatment reassessment and biopsychosocial evidence-based care. Perceived expectations of GPs as the ‘last resort’ may perpetuate opioid use and impede collaborative care with the patient and multi-disciplinary teams.