The secret ingredient?
non-malignant pain, pain
No one factor or ‘secret ingredient’ was identified but rather a combination of active ingredients as enablers of opioid tapering. The I-WOTCH intervention seemed to have a synergistic, summative effect from its different components which could be specific to the individual. The qualitative data indicate that the intervention served to inform and provide a forum where discussion in groups and in one-to-one sessions could help people decide whether to reduce their opioid use. The final decision was the participant’s, and no judgements were made about whether or when they might start tapering.The I-WOTCH intervention provided a space in which people could fill gaps in their knowledge of opioids. The intervention also enhanced motivations to taper, including intrinsic motivations that participants brought to the sessions. Information provided by the intervention about the lack of long-term effectiveness and side effects developed motivation. This was emphasised in staff interviews which highlighted how provision of information about opioid use consequences was, for some participants, a turning point in becoming motivated to change. Support from their GP, their family, the I-WOTCH one-to-one meetings, the tapering plan and group peers also enhanced motivation. Exploring pain management skills in a group over three sessions allowed them to try things out and swap ideas, so establishing the skill base needed for change.The Information, Motivation and Behavioural Skills modelThese findings correspond to a wider literature. A 2020 qualitative evidence synthesis using meta-ethnography (31 studies) looking at experiences of people taking opioids for chronic non-malignant pain by the current authors,Our findings are also broadly supported by recent literature. Goesling We identified GPs as integral to tapering support. Three 2020–2022 papers from healthcare providers perspectiveThere is a long history of successful use of small groups to develop support, share common health problems, build trust, share ideas, enhance information, change attitudes and develop motivation and skills to promote health behaviour change.