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.