Table 2

Supporting Qualitative Data for Primary Themes

Theme 1: What FPs were taught vs current expectations
“I came out of school in [the 1990s]. At that point, we were undertreating chronic pain, so we were told. So we were quite gung-ho about not under-treating pain, and using opioids because they were supposedly safer than anti-inflammatories. And now, the pendulum has swung … there’s new evidence that it might actually not be doing them any good.” P04
“I’m convinced we have to do things a lot safer, but if we go too far the other way, we’re protecting our own licenses perhaps, and maybe controlling the street supply of opioids, but I don’t know if it’s the very best thing for patient care.” P01
Theme 2: Navigating tensions between the FP’s role and patient and system expectations
 “I think there’s [an expectation that] we need to be police officers at the same time as physicians, that’s always a conflict. As a physician, I can’t function if I don’t believe my patients. But there’s this overarching responsibility medically and legally for me to make sure I’m also suspicious of patients. So that’s a very big internal struggle.” P12
 “It always goes back to the family doc. It’s very rare [for anyone] to say, well, now I’ll take this over, I’ll prescribe their opioids [or manage their pain]. It’s more often that they’re like, here’s some advice, go follow up with your family doctor.” P04
“[Patients] probably [have an opioid started] sometime during their hospitalization and then they just continued on opioids because of pain related issues. Unfortunately they probably have escalating doses of opioid and nobody actually addressed that, or no one actually attempts to wean them down or try other interventions.” P03
 “I know that new recommendations have come out, I try but I’m not going to change my practice if I think that the patients are stable and well on them… . I think if I’m accurate and they are truthful and they are stable, I don’t think I’m going to make a huge effort to change it at this point in time.” P017