The dilemma of repeat weak opioid prescriptions – experiences from swedish GPs

• Main Authors: Elsa Ekelin, Anders Hansson
• Format: Article
• Language: English
• Published: Taylor & Francis Group 2018-04-01
• Series: Scandinavian Journal of Primary Health Care
• Subjects: General practitioners; drug prescriptions; codeine; tramadol; cognitive dissonance; ethics; medical; research; qualitative
• Online Access: http://dx.doi.org/10.1080/02813432.2018.1459241

Objective: To explore general practitioners’ (GP) experiences of dealing with requests for the renewal of weak opioid prescriptions for chronic non-cancer pain conditions. Design: Qualitative focus group interviews. Systematic text condensation analysis. Setting and subjects: 15 GPs, 4 GP residents and 2 interns at two rural and two urban health centres in central Sweden. Main outcome measures: Strategies for handling the dilemma of prescribing weak opioids without seeing the patient. Results: After analysing four focus group interviews we found that requests for prescription renewals for weak opioids provoked adverse feelings in the GP regarding the patient, colleagues or the GP’s inner self and were experienced as a dilemma. To deal with this, the GP could use passive as well as active strategies. Active strategies, like discussing the dilemma with colleagues and creating common routines regarding the renewal of weak opioids, may improve prescription habits and support physicians who want to do what is medically correct. Conclusion: Many GPs feel umcomfortable when prescribing weak opioids without seeing the patient. This qualitative study has identified strategic approaches to deal with that issue.Key points   Opioid prescription for chronic non-cancer pain is known to cause discomfort, feelings of guilt and conflicts for the prescribing doctor. From focus group interviews with GPs we found that to deal with this:   • Doctors can use active strategies, such as confronting the patient or creating common routines together with their colleagues, or…   • They can use passive coping strategies such as accepting the situation, handing over the responsibility to the patient or choosing not to see that there is a problem.   • Opportunities for doctors to discuss prescription routines may be the best way to influence prescription habits.