Stages of change 

As a pharmacy professional, it can be difficult to feel that any progress is being made when dose reduction isn’t achieved. Choosing to see the reduction of opioid use in long-term pain management as more than just taking less medication, and understanding that it also involves behaviour change, can help with this. The Stages of Behaviour Change model describes the five phases through which an individual progresses during a health-related behaviour change.³ 

1. Precontemplation (unaware of the problem)
2. Contemplation (aware of the problem and of the desired behaviour change)
3. Preparation (intends to take action)
4. Action (practices the desired behaviour)
5. Maintenance (works to sustain the behaviour change).

A person looking to reduce their long-term opioid use will go through this process, but the length of time they spend at each stage will vary considerably. Establishing where a person is in this process can help you to tailor your conversations. For example, a conversation with someone who is certain they cannot reduce their opioids will be different from that with someone who is concerned about having been on opioids for five years and wants support to stop taking them. 

Your interaction may help to move a person on to the next stage. After talking with you, they may move from precontemplation (not thinking their opioids were causing any issues) to being aware that a change may be needed. This is an important stage that will set the foundation for achieving the goal of opioid reduction and may be a helpful evaluation tool when considering the effectiveness of a service. However, it is easy to miss a change in attitude because of the way outcomes are commonly measured, so it is important to be alert to this.