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Background: pain management is a priority in palliative care because it has a huge impact on quality of life. However, many medical residents have difficulties with the prescription of strong opioids though they are highly indicated in intense pain. Aim : The aim of our study was to explore the medical residents’ representations expressed toward opioids’ prescription and their links to professional practices in order to improve them. Methods: a descriptive qualitative monocentric method was chosen. Semi-structured interviews were conducted with oldest medical residents from the University of Bordeaux. These interviews were leading by interviews’ frame. This frame was built from a brainstorm grid of representations’ patterns about opioids’ prescriptions ; theoretical knowledges, experiences and beliefs. The transcription of the interviews named as verbatim were analyzed. Results: 12 semi-directed interviews were conducted before data saturation was achieved. Pain measurements were subjective, prescribing modalities were poorly knew. Mentorship and palliative care team’s help were factors that positively influenced the opioids ‘prescription. Fears and reluctance were broadly based on the addictive risk and side effects of opioids. Discussion: the resident’s difficulties about opioids’ prescriptions were similar to those of the medical literature. The prescription context is influenced by historical opiophobia and confusing American news (opioid crisis) that confronts to misuse and drift. Pain management skills are acquired through relevant academic training and quality mentorship. Conclusion: mentalities about opioid’s prescriptions evolves in a positive way with a more suitable and adapted prescription. Continuing dissemination of the palliative culture, companionship and developing innovative teaching methods could improve the representations of opioids’ prescription in the general practice., Objectif : l’objet de cette étude était de déterminer les représentations de la prescription de morphiniques chez les internes de médecine générale en fin de cursus à Bordeaux. Méthode : une méthode qualitative descriptive monocentrique a été choisie. Des entretiens semi-dirigés ont été réalisés auprès d’internes de médecine générale de l’université de Bordeaux en fin de cursus, tirés au sort. Ces entretiens suivaient une trame d’entretien établie à partir d’une grille de réflexion sur les différents aspects des représentations de la prescription ; les connaissances théoriques, les vécus et expériences et les croyances. Résultats : 12 entretiens semi dirigés ont été réalisés avant d’obtenir une saturation des données. Les modalités technico-pratiques de prescription des morphiniques, l’évaluation de la douleur, les indications et modalités de prescription étaient peu maitrisés. La séniorisation et le recours à l’EMSP étaient des éléments qui conditionnaient positivement la prescription d’opioïdes forts. Les réticences étaient globalement fondées sur le risque addictif et les effets secondaires des morphiniques ainsi que sur les croyances des autres acteurs de soins. Discussion : Les difficultés rencontrées rejoignent celles de la littérature. Le contexte de prescription est marqué par une opiophobie historique et une actualité américaine déroutante qui confronte au mésusage et à la dérive. La compétence de prise en charge de la douleur s’acquiert grâce à une formation universitaire pertinente et à une séniorisation de qualité. Conclusion : l’évolution des mentalités vis à vis de la prescription des morphiniques est positive avec une prescription plus raisonnée et adaptée. La poursuite de la diffusion de la culture palliative, du compagnonnage pour un meilleur « savoir-faire » et la mise en œuvre de méthodes pédagogiques innovantes pourraient améliorer les représentations de la prescription d’opioïdes forts chez les internes de médecine générale.

Background : Pain management is a priority in palliative care because it has a huge impact on quality of life. However, many medical residents have difficulties with the prescription of strong opioids though they are highly indicated in intense pain. Aim : The aim of our study was to explore the medical residentsu2019 representations expressed toward opioidsu2019 prescription and their links to professional practices in order to improve them. Methods : A descriptive qualitative monocentric method was chosen. Semi-structured interviews were conducted with oldest medical residents from the University of Bordeaux. These interviews were leading by interviewsu2019 frame. This frame was built from a brainstorm grid of representationsu2019 patterns about opioidsu2019 prescriptions ; theoretical knowledges, experiences and beliefs. The transcription of the interviews named as verbatim were analyzed. Results : 12 semi-directed interviews were conducted before data saturation was achieved. Pain measurements were subjective, prescribing modalities were poorly knew. Mentorship and palliative care teamu2019s help were factors that positively influenced the opioids u2018prescription. Fears and reluctance were broadly based on the addictive risk and side effects of opioids. Discussion : The residentu2019s difficulties about opioidsu2019 prescriptions were similar to those of the medical literature. The prescription context is influenced by historical opiophobia and confusing American news (opioid crisis) that confronts to misuse and drift. Pain management skills are acquired through relevant academic training and quality mentorship. Conclusion : Mentalities about opioidu2019s prescriptions evolves in a positive way with a more suitable and adapted prescription. Continuing dissemination of the palliative culture, companionship and developing innovative teaching methods could improve the representations of opioidsu2019 prescription in the general practice.