PhD defence: Pain Points - Patient Perspectives on Opioid Treatment for Chronic Pain

In the Netherlands, opioids are frequently prescribed for severe pain, such as after surgery or for cancer. In recent years, however, an increasing number of patients have been receiving these medications for chronic pain, even though there is no evidence that they are effective in the long term. In fact, prolonged use can lead to serious side effects, opioid use disorder and even fatal respiratory problems.

Since 2020, over one million Dutch patients have been prescribed opioids annually, with more than a quarter using them long term. This thesis examines how patients experience their opioid use and the associated care, offering recommendations to make pain management safer and to reduce unnecessary long-term use.

A key finding is that patients require better information at the time of the initial prescription, including clear explanations of how the drug works, risks and alternatives. They also emphasise that tapering should be discussed earlier and more regularly, with specific attention to the chronic pain experience. All involved healthcare providers must convey this information consistently and repeatedly. Furthermore, patients seek more support during the tapering process, favouring shared treatment goals, alternative pain management options and clear agreements on the pace of tapering, the option for medication rotation and the tapering location. Patients believe that both their treating physician and their pharmacist play an important role in ensuring the safe use of opioids and in the timely detection of potential risks.

Although there is currently no opioid crisis in the Netherlands as there is in the United States – and stakeholders consider the risk of large-scale leakage to the illegal market to be low – vigilance remains essential. With the emergence of new illegal substances readily available online, it is crucial to continue strengthening preventive measures and encourage active patient involvement to ensure safe pain management.