Abstract
BACKGROUND: Prescribing high-potency opioids for chronic non-cancer pain has increased in Germany, despite limited evidence of long-term efficacy. General practitioners write approximately 87% of all opioid prescriptions. The guideline "Long-term use of opioids for chronic non-cancer pain" (LONTS) provides recommendations for responsible opioid management, but its uptake in primary care remains unclear. OBJECTIVE: This study investigates how general practitioners apply LONTS guideline recommendations and identifies barriers to implementation. METHODS: A mixed-methods study was conducted, including an online questionnaire to detect deviations from LONTS recommendations, followed by semi-structured telephone interviews to explore barriers for guideline adherence. RESULTS: A total of 131 questionnaires and 21 interviews with general practitioners were analyzed. 45% of questionnaire participants were unfamiliar with the LONTS guideline. Four key gaps were identified: (i) Nearly 40% of general practitioners rarely or never set individualized treatment goals for chronic pain patients; (ii) 49% preferred combining long-acting opioids at fixed intervals with short-acting opioids on demand; (iii) 17% used short-acting opioid monotherapy, considered a treatment error; (iv) 44% did not discuss opioid reduction or discontinuation after 6 months of effective pain relief. Qualitative analysis identified key barriers: lack of integration into daily routines, anticipating patients' fear of pain recurrence, and preference for personal experience over evidence. CONCLUSION: General practitioners in Germany may struggle to implement LONTS recommendations for opioid use in chronic non-cancer pain. Targeted strategies are needed to promote and improve the adoption of these guidelines in primary care.