• Eric J Hawkins, Aline M Lott, Anissa N Danner, Carol A Malte, Hildi J Hagedorn, Douglas Berger, Lucas M Donovan, George G Sayre, Anthony J Mariano, and Andrew J Saxon.
• Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, USA.
• Pain Med. 2021 Jul 25; 22 (7): 1559-1569.

ObjectiveDue to increased risks of overdose fatalities and injuries associated with coprescription of opioids and benzodiazepines, healthcare systems have prioritized deprescribing this combination. Although prior work has examined providers' perspectives on deprescribing each medication separately, perspectives on deprescribing patients with combined use is unclear. We examined providers' perspectives on coprescribed opioids and benzodiazepines and identified barriers and facilitators to deprescribing.DesignQualitative study using semistructured interviews.SettingOne multisite Veterans Affairs (VA) healthcare system in the United States of America.SubjectsPrimary care and mental health prescribers, key clinical leaders, clinical pharmacist specialists (N = 39).MethodsInterviews were audio-recorded, transcribed, and analyzed using thematic analysis. Themes were identified iteratively, through a multidisciplinary team-based process.ResultsAnalyses identified four themes related to barriers and facilitators to deprescribing: inertia, prescriber self-efficacy, feasibility of deprescribing/tapering, and promoting deprescribing, as well as a fifth theme, consequences of deprescribing. Results highlighted the complexity of deprescribing when multiple prescribers are involved, a need for additional support and time, and concerns about patients' reluctance to discontinue these medications. Facilitators included agreement with the goal of deprescribing and fear of negative consequences if medications are continued. Providers spoke to how deprescribing efforts impaired patient-provider relationships and informed their decisions not to start patients on these medications.ConclusionsAlthough providers agree with the goal, prescribers' belief in a limited deprescribing role, challenges with coordination among prescribers, concerns about insufficient time and patients' resistance to discontinuing these medications need to be addressed for efforts to be successful.Published by Oxford University Press on behalf of the American Academy of Pain Medicine 2021.

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