Independent pharmacist Sukhi Basra explains why community pharmacy must lead on opioid deprescribing – and why deprescribing should be a nationally commissioned pharmacy service…

In community pharmacy, our role is often underestimated, until you need us! On any given day in my practice, I’ll see a wide cross-section of society: a new mum managing postnatal pain, an elderly woman juggling arthritis and caring for grandchildren, or a busy working parent asking for “something stronger” because paracetamol just isn’t cutting it.

Each patient walks in with symptoms, yes, but they also bring assumptions, fears, and a firmly held belief that they know what they need. Often, that belief includes opioids.

The story behind the script

Let’s be honest, nobody wakes up wanting to be dependent on painkillers. But between chronic pain, patchy access to other services, and a healthcare system that often rushes to medicate before it educates, that’s exactly what happens. What begins as short-term relief can quietly slide into long-term reliance.

In my London pharmacy, serving a wonderfully diverse and often underserved community, I’ve seen this first-hand. Many of my patients, especially women from lower socioeconomic or multilingual backgrounds, live in a swirl of competing pressures: limited health literacy, multiple responsibilities, and rarely enough time or trust in the system to ask the right questions.

Take the woman who came in seeking co-codamol to help her sleep. She’d had it after surgery and just...kept taking it. English wasn’t her first language. She hadn’t seen her GP in months due to childcare, work, and life pressures. She assumed it was safe because it had once been prescribed.

That 15-minute conversation, covering pain, dependency, and real alternatives might have changed her health trajectory. But without us, she might never have had it.

Why deprescribing matters and why it should be funded

Deprescribing isn’t a buzzword. It’s not a ‘nice to have’. It’s a public health intervention.

In 2019, Public Health England revealed over half a million people in England were taking opioids for longer than three months, often with higher rates in more deprived communities. We know long-term opioid use can cause more harm than good, including dependency, tolerance, and withdrawal.

And yet, as Bužančić et al. (2022) found in their systematic review, community pharmacy-led deprescribing initiatives are both clinically effective and economically wise, especially when pharmacists are empowered to lead structured reviews.

That’s why I believe deprescribing should be a nationally commissioned pharmacy service. We’re already doing this work informally: having conversations, raising red flags with GPs, supporting safer step-downs. But without formal structure, time, or funding, we’re doing it off the side of our desks in between the 200 other things we’re responsible for.

The EY Report (2023) supports this too, highlighting that empowering community pharmacies could save the NHS up to £1.9 billion annually, simply by better using our clinical expertise.

Not just clinical but cultural

Deprescribing isn’t just about changing the dose. It’s about challenging beliefs. Patients often come in asking for a medicine they’re sure they need. My job, our job, is to pause that momentum.

To educate, to reframe, and to offer safer, evidence-based alternatives. Sometimes it's about co-creating tapering plans.

Sometimes it's simply validating their pain and opening new options like physio, mental health support, or over-the-counter strategies they didn’t realise existed such as naproxen, a strong and long-lasting pain medicine recently reclassified from POM to P for acute musculoskeletal pain in a move driven by the healthcare company Maxwellia.

Crucially, this is where trust makes all the difference. Unlike many parts of the system, community pharmacists are consistently available. We build relationships over time. That rapport is a powerful tool in guiding patients toward safer decisions.

The gender and health literacy gap

It’s important to talk about who’s at greatest risk. Women, particularly those juggling caregiving, work, and chronic pain are often disproportionately affected by poor pain management. And when health literacy is low, it doesn’t just affect them, it affects their families, their children, and their ability to advocate for their own wellbeing.

As Medina-Perucha et al. (2020) pointed out, women on opioid substitution therapy face persistent barriers to care and pharmacists are well-positioned to break those down. But again, only if we’re equipped and supported to do so.

Time for leadership

It’s time Community Pharmacy England steps up and advocates for a nationally funded opioid deprescribing service led by pharmacists. We have the skills. We have the access. We have the trust of our patients. Now we need the infrastructure.

Because pharmacy isn’t just about pills, it’s about people. And in the right hands, deprescribing can be as powerful as prescribing ever was.

Sukhi Basra is vice-chair of the National Pharmacy Association, an independent prescriber at Clinichem Pharmacy in London and founder of The London PharmaClinic.