Realities of opioid and gabapentinoid deprescribing in socioeconomically disadvantaged communities: qualitative evaluation.

Abstract

Opioid and gabapentinoid prescribing has increased substantially in recent years despite having limited effectiveness in treating chronic primary pain. This is concerning with the prescribing rates and adverse effects of these medications being higher in more socioeconomically disadvantaged groups. Guidance for prescribing and deprescribing these medications exists but the understanding of how deprescribing is operationalised especially in areas of socio-economic disadvantage is limited. To explore primary healthcare professionals' views and experiences of designing and implementing an intervention to reduce opioid and gabapentinoid prescribing. A qualitative evaluation, using participant observation and semi-structured interviews with primary healthcare professionals working in practices serving areas of substantial socio-economic disadvantage. Interviewees were purposively recruited with subsequent snowballing with participant observation of the peer-support meetings. Interviews transcripts and notes from the participant observation were inductively coded and thematically analysed. Thirteen healthcare professionals from five practices were interviewed. Person-centred care with shared decision-making was strived for which was time consuming due to the complexity of the problem and patients. Where shared-decision making was not possible due to patient refusal or non-engagement, risk was used to determine the appropriate action. This work involved an emotional toll on staff and patients but was at times conversely easier and more rewarding than expected. Ultimately, demedicalising pain with a culture change is required to ensure patients are not prescribed these medications for inappropriate reasons or doses. This study demonstrates key operational aspects to consider when undertaking opioid and gabapentinoid deprescribing in primary care.