loading page

A review of trial and real-world data applying a realist approach to identify behavioural mechanisms supporting practitioners to taper opioids
  • +4
  • Hattie Whiteside,
  • Emma Tang,
  • Kumud Kantilal,
  • Yoon Loke,
  • Bethany Atkins,
  • Caroline Hill
University of Leicester College of Life Sciences

Corresponding Author:[email protected]

Author Profile
Hattie Whiteside
University of East Anglia
Author Profile
Emma Tang
University of East Anglia
Author Profile
Kumud Kantilal
University of East Anglia
Author Profile
Yoon Loke
University of East Anglia
Author Profile
Bethany Atkins
University of East Anglia
Author Profile
Caroline Hill
University of East Anglia
Author Profile


This realist enquiry applying behavioural theory aimed to identify behavioural mechanisms and contexts that facilitate prescribers tapering opioids. We identified relevant opioid tapering interventions and services from a 2018 international systematic review and a 2019 England-wide survey, respectively. Interventions and services were eligible if they provided information about contexts and/or behavioural mechanisms influencing opioid tapering success. A stakeholder group (n=23) generated draft programme theories based around the 14 domains of the theoretical domains framework. We refined these using the trial and service data. From 71 articles and 21 survey responses, 56 and 16 respectively were included, representing primary care, hospital, specialist pain facilities and prison services. We identified six programme theories that included five behavioural mechanisms: prescribers’ knowledge about how to taper; build prescribers’ beliefs about capabilities to initiate tapering discussions and manage psychological consequences of tapering; perceived professional role in tapering; the environmental context enabling referral to specialists; and facilitating positive social influence by aligning patient: prescriber expectations of tapering. No interventions are addressing all six mechanisms supportive of tapering. Work is required to operationalise programme theories according to organisational structures and resources. An example operationalisation is combining tapering guidelines with information about local excess opioid problems and endorsing these with organisational branding. Prescribers being given the skills and confidence to initiate tapering discussions by training them in cognitive-based interventions and incorporating access to psychological and physical support in the patient pathway. Patients being provided with leaflets about the tapering process and informed about the patient pathway.
28 Nov 2021Submitted to British Journal of Clinical Pharmacology
29 Nov 2021Submission Checks Completed
29 Nov 2021Assigned to Editor
02 Dec 2021Reviewer(s) Assigned
27 Dec 2021Review(s) Completed, Editorial Evaluation Pending
29 Dec 2021Editorial Decision: Revise Minor
18 Jan 20221st Revision Received
19 Jan 2022Assigned to Editor
19 Jan 2022Submission Checks Completed
19 Jan 2022Review(s) Completed, Editorial Evaluation Pending
19 Jan 2022Reviewer(s) Assigned
15 Feb 2022Editorial Decision: Revise Minor
22 Feb 20222nd Revision Received
23 Feb 2022Assigned to Editor
23 Feb 2022Submission Checks Completed
23 Feb 2022Review(s) Completed, Editorial Evaluation Pending
03 Mar 2022Editorial Decision: Accept