Background Opioid and gabapentinoid prescribing has increased in recent years despite limited effectiveness in treating chronic primary pain. Chronic pain is more common in people with lower socio-economic status and the prescribing rates and adverse effects of these medications are higher in socioeconomically disadvantaged groups, leading to concerns around the medicalisation of distress. Guidance for opioid/gabapentinoid prescribing and deprescribing supports person-centred care with shared decision-making. However, understanding how deprescribing is operationalised, especially in areas of socio-economic disadvantage, is limited.

The North East and North Cumbria (NENC) Deep End Network piloted allocating protected funded time (one weekly session for six months to backfill GPs’/allied professionals’ time) for practices to reduce opioid/gabapentinoid prescribing in high-risk patients. Practices had flexibility to decide their approach, with monthly peer-support meetings provided.

Research Aim to explore primary healthcare professionals' views and experiences of designing and implementing an intervention to reduce opioid/gabapentinoid prescribing in high-risk patients in more deprived areas.

Methods A qualitative evaluation of self-selecting NENC Deep End practices, serving areas of substantial socio-economic disadvantage, using semi-structured interviews with a topic guide, informed by Normalisation Process Theory. Primary healthcare professionals were purposively recruited with subsequent snowball sampling and participant observation of peer-support meetings. Interviews transcripts and researcher notes from the meetings were inductively coded and thematically analysed.

Results Thirteen primary healthcare professionals (7 GPs; 6 pharmacists, pharmacy technicians or allied 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. This included considering the patients' needs and factors in the patients' lives potentially affecting their capacity to engage. Offering flexibility and support during deprescribing was important. Shared decision-making was desirable, sometimes perceived risk was prioritised to determine the appropriate action, including forced reductions by some practices. This work involved difficult decisions with an emotional toll on staff and patients. At times, it was conversely easier and more rewarding than expected. Ultimately, shifting culture towards demedicalising pain, when and where appropriate, ensuring patients are not prescribed these medications for inappropriate reasons or doses, was seen as key.

Conclusion This study outlines important considerations for opioid/gabapentinoid deprescribing in primary care in socio-economically disadvantaged areas including allocating dedicated time, adopting a systematic and person-centered approach, providing support for staff and patients, and the need to foster wider cultural change towards the demedicalisation of distress with a focus on non-pharmaceutical responses.