Skip to main content

Research Repository

Advanced Search

Logic model for opioid safety in chronic non-malignant pain management, an in-depth qualitative study

Anderson, Claire; Iqbal, Ayesha; Knaggs, Roger; Toh, Li Shean


Ayesha Iqbal


Background Opioids are commonly used for the management of chronic non-malignant pain in Pakistan; but there is a lack of literature around precursors or motivators in the use of opioids.
Aim The study holistically explored factors contributing towards the unsafe use of opioids and identifies strategies to over- come them.
Method Exploratory qualitative methods using interviews, focus groups and non-participant observational case studies were used. Interviews and focus groups were carried out face-to-face as well as virtually and observations were conducted in com- munity pharmacies in Islamabad and Khyber Pukhtoon Khuwa province, Pakistan. Data were collected from 4 stakeholder groups; pharmacy policy makers (n=11), people with chronic non-malignant pain (n=14), doctors (n=31) and community pharmacists (n = 36) by purposive critical case sampling method. Data were analysed inductively using reflexive thematic analy- sis and then deductively mapped to a social ecological framework. Non-participant observations were analysed using a cross case synthesis using explanation building technique. Data from all three methods were triangulated to develop a logic model. Results Identified factors at macro (regulation), meso (social perceptions of pain and opioids) and micro levels (uncontrolled pain, self-medication, health literacy) and strategies are presented holistically and were used to develop a logic model for the prevention and mitigation of factors currently causing unsafe use of opioids.
Conclusion The study provides an in-depth view of factors contributing towards diversion of pharmaceutical opioids and can help guide national and international policy makers in their future initiatives to promote safe use of opioids in the manage- ment of chronic non-malignant pain in Pakistan.


Anderson, C., Iqbal, A., Knaggs, R., & Toh, L. S. (2023). Logic model for opioid safety in chronic non-malignant pain management, an in-depth qualitative study. International Journal of Clinical Pharmacy, 45, 220-232.

Journal Article Type Article
Acceptance Date Sep 20, 2022
Online Publication Date Nov 25, 2022
Publication Date 2023-02
Deposit Date Nov 28, 2022
Publicly Available Date Dec 1, 2022
Journal International Journal of Clinical Pharmacy
Electronic ISSN 2210-7711
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 45
Pages 220-232
Public URL
Publisher URL


You might also like

Downloadable Citations