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.

BACKGROUND

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.

AIM: To investigate the barriers and motivators to opioid deprescribing among adults with CNCP, receiving long-term treatment with short-acting opioids in primary care.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.