Can pharmacists help end the opioid epidemic?

Imagine a world where every high-dose opioid prescription is questioned, where patients are supported to manage pain safely, and where pharmacists are central to a new approach in pain management. At WellBN in Brighton, we’ve discovered that this is not only possible, it is deeply rewarding.

Deprescribing often feels daunting. Reducing or stopping long-term high-dose opioids can seem overwhelming, even risky. Yet our experience at WellBN shows that with teamwork and a structured approach, it is achievable and transformative for both patients and practices.

Across the UK, many patients are prescribed dangerously high opioid doses for non-cancer pain. Some of our patients were taking over 120mg of morphine daily, doses where harm escalates dramatically while evidence of benefit is minimal. The World Health Organization estimated that 125,000 people died of opioid overdose in 2019. While illicit opioids drive much of this crisis, primary care prescribing contributes to unnecessary risks.

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We knew doing nothing was not an option, but we also understood why clinicians hesitate. Concerns about withdrawal, patient resistance, and time pressures can all stall action. We wanted to show that change is possible, even in a busy GP practice.

A key insight was that deprescribing cannot be the work of a single profession. Pharmacists bring medication expertise, safe tapering plans, and prescribing oversight. Physiotherapists provide essential support in helping patients reframe their relationship with pain, develop self-management strategies, and build confidence in non-drug alternatives.

We developed a pathway combining both perspectives. Patients on high-dose opioids were identified through prescribing data and invited for joint reviews. These reviews focused on three principles: patient-centred communication, acknowledging fears and validating lived experience; shared decision-making, setting goals together rather than imposing change; and practical alternatives, offering physiotherapy input, pacing advice, and non-opioid strategies alongside a tailored tapering plan.

This approach proved powerful. Patients felt supported, not 'cut off', and understood the risks and realities of their medication.

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Over a six-month period, we reviewed every patient in our practice taking high-dose opioids. The outcomes were encouraging. Several patients reduced their dose significantly, with some cutting it by more than half, and a number successfully stopped opioids altogether. Importantly, no patients escalated to higher doses or experienced unmanageable withdrawal. Many reported improved function and quality of life, often expressing surprise that they felt better on lower doses.

From the practice perspective, the benefits were clear. Clinical risk was reduced, prescribing costs were lowered, and the practice strengthened its reputation for proactive, safe patient care. Our work was recently recognised with an innovation and leadership award in primary care opioid management, motivating us to continue supporting more patients and sharing our model.

The key message is simple. Deprescribing high-dose opioids is feasible. It does not require specialist pain services, elaborate funding, or months of preparation. What it does need is commitment, teamwork, and a willingness to start the conversation.

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Pharmacists considering this work can focus on five practical approaches.

1. Work together. Pharmacists and physiotherapists form a strong partnership, and support from GPs and nurses strengthens the model further.
2. Be patient-centred, engaging with patients’ fears and hopes rather than dictating a plan.
3. Start small. Even a reduction of 10mg morphine equivalent is a win and helps build momentum.
4. Collect data. Tracking outcomes demonstrates impact, motivates the team, and reassures leadership.
5. It may be easier than expected. Many patients, once informed of the limited benefits and risks of their opioids, are willing to explore alternatives without needing replacement medication.

The opioid crisis is not a distant news story. It is here in our practices, among our patients. Every high-dose prescription represents a person at risk. Our message to pharmacists is simple: question every opioid prescription you dispense or prescribe. Challenge assumptions, start the conversation, and work as a team to offer safer, more effective pain management. Together, we can make a real difference.