Background Prescribing of opioid medication has increased over the last twenty years. Most occurs in primary care for chronic pain. There is little evidence that these drugs are effective for this indication and concerns about continuing prescribing, particularly in the long term and at high doses.

Aim Exploration of general practitioners’ (GPs’) experiences of prescribing opioids, problems encountered and factors militating against good prescribing practice.

Design and Setting Qualitative interviews with GPs who prescribe opioids in primary care in North-East Wales.

Method Semi-structured interviews with 20 GPs were transcribed and subjected to thematic analysis utilising the framework approach.

Results Participating GPs identified a range of problems associated with prescribed opioids; they were concerned about limited effectiveness of the drugs and what they perceived as addiction resulting from their use. They identified healthcare system factors that were obstacles to rational prescribing, such as lack of continuity of care and poor access to secondary care pain management support; the most important of these factors was constant time pressure. They reported adverse effects on relationships with patients. Unrealistic expectations that pain could be eliminated resulted in pressure to prescribe stronger drugs and increased doses; it led to difficulties in establishing and maintaining trust and in persuading patients to agree to, and to carry out, dose reductions.

Conclusion Themes emerging from this study suggest that GPs lack appropriate control of opioid prescribing. There is a need to develop methods to help patients and GPs to work together to manage chronic pain safely.