From high-dose opioids to sustainable wellbeing: a multidisciplinary deprescribing model in general practice

WellBN

Project summary

At WellBN GP Practice, high-dose opioid prescribing was significantly above the national average, placing patients at increased risk of harm. In early 2020, a pharmacist-led initiative was launched to address this through a structured, multidisciplinary deprescribing model.

We identified 213 patients prescribed opioids, including 42 patients receiving high-dose opioids (≥120 mg morphine equivalent daily). A dedicated clinic was established, where 145 patients were reviewed directly. The approach moved beyond traditional medication reviews by integrating physiotherapy, social prescribing, and access to creative and complementary therapies including art therapy, singing groups, and wellbeing activities.

A key principle underpinning the project was that opioids could not simply be removed without offering meaningful alternatives. Joint pharmacist and physiotherapist clinics were introduced, enabling patients to receive both clinical review and practical support to manage pain through movement, rehabilitation, and self-management strategies. Patients were also supported to engage with non-pharmacological interventions to improve wellbeing.

Outcomes were significant. Of patients reviewed, 112 (53%) reduced their opioid dose and 49 (23%) discontinued opioids completely, meaning 76% have already reduced or stopped. The remaining patients continue to engage in structured reduction plans. Patients initially reported anxiety about reducing opioids, but this shifted to increased confidence, with many describing improved function, wellbeing, and control over their pain.

At a population level, high-dose opioid prescribing reduced rapidly from approximately 30% to below 6% in 2020, moving the practice from among the highest prescribers nationally to below the national average. This improvement has been sustained for six years.

In addition to improving patient safety and outcomes, the project delivered clear value. Reduced prescribing has generated ongoing cost savings, while improved patient function has the potential to reduce wider healthcare utilisation.

This project demonstrates that opioid deprescribing can be delivered safely and effectively in general practice when supported by a multidisciplinary, patient-centred model. The approach is scalable and transferable, providing a practical framework for addressing overprescribing and improving patient wellbeing.