Experience of opioid cessation after surgery in opioid-naïve patients in the United Kingdom: A qualitative study

Abstract

Background

Opioid analgesia is frequently prescribed after surgery, with the expectation that patients will cease use within weeks, yet up to 25% of opioid-naïve patients may develop persistent postoperative opioid use. Opioid stewardship interventions are increasingly used to mitigate this risk, but little is known of the psychological factors influencing successful opioid cessation in the community after surgery in the UK.

Aim

To identify psychological factors influencing opioid use and cessation after discharge following surgery in the UK.

Design

Interviews with post-surgical patients 3 months after discharge; qualitative framework analysis summarised as themes.

Methods

Opioid-naïve patients discharged on opioids after all-type surgery were invited three months later to a telephone interview that explored their experience of reducing opioids at home, and what influenced these decisions. Data were transcribed and qualitatively analysed.

Results

48 participants were interviewed: all had ceased opioid use within one month of surgery. Four themes, comprising 15 subthemes, described diverse considerations: relationship with opioids – balance of benefits and risks; relationship with pain; relationship with clinicians; and views about addiction, including moral perspectives.

Conclusion

Those interviewed made complex decisions on tapering opioids drawing on beliefs and previous experiences, relationships to healthcare, and prior experiences of pain. The themes identified lend further support, in the UK healthcare setting, to specific opioid stewardship interventions, especially patient education, pack-size limitation, and transitional pain services.