Primary Care and Mental Health Prescribers, Key Clinical Leaders, and Clinical Pharmacist Specialists’ Perspectives on Opioids and Benzodiazepines

Abstract Objective Due to increased risks of overdose fatalities and injuries associated with coprescription opioids benzodiazepines, healthcare systems have prioritized deprescribing this combination. Although prior work has examined providers’ perspectives on each medication separately, patients combined use is unclear. We coprescribed benzodiazepines identified barriers facilitators deprescribing. Design Qualitative study using semistructured interviews. Setting One multisite Veterans Affairs (VA) system in the United States America. Subjects Primary care mental health prescribers, key clinical leaders, pharmacist specialists (N = 39). Methods Interviews were audio-recorded, transcribed, analyzed thematic analysis. Themes iteratively, through a multidisciplinary team-based process. Results Analyses four themes related deprescribing: inertia, prescriber self-efficacy, feasibility deprescribing/tapering, promoting deprescribing, as well fifth theme, consequences highlighted complexity when multiple prescribers are involved, need for additional support time, concerns about patients’ reluctance discontinue these medications. Facilitators included agreement goal fear negative if medications continued. Providers spoke how efforts impaired patient-provider relationships informed their decisions not start Conclusions providers agree goal, prescribers’ belief limited role, challenges coordination among insufficient time resistance discontinuing be addressed successful.