Abstract / Summary
Background/Objectives: Chronic pain is common in Saudi Arabia, where opioid analgesics are prescribed and dispensed within a tightly regulated, electronically monitored controlled-substance framework. Qualitative evidence on how patients experience restrictive access comes almost entirely from high-consumption countries; to our knowledge, no study has examined these experiences among Saudi adults with chronic non-cancer pain or linked them to how patients appraise non-opioid alternatives. This study explored opioid access, stigma and therapeutic trust among adults with chronic non-cancer pain in Al-Ahsa and examined the anticipated acceptability of non-opioid drug-delivery systems. Methods: A qualitative interview study was conducted across seven public and private health settings in Al-Ahsa (May–June 2026). Thirty adults with chronic non-cancer pain were purposively sampled for maximum variation; 12 clinicians were also interviewed to contextualise the service conditions patients described, with patient accounts remaining the analytic focus. Sample adequacy was judged using information power, i.e., the capacity of a specific sample and focused dialogue to address a narrow aim. Data were analysed using reflexive thematic analysis and reported according to COREQ. Results: Four themes were constructed: navigating a restricted access pathway (“A door with many locks”); enacted and anticipated stigma (“As if I came to steal”); institutional distrust alongside trust in individual clinicians (“The person, not the system”); and conditional, anticipated acceptability of topical and transdermal non-opioid formats (“Something I can put on my skin”). Conclusions: Participants described restrictive opioid pathways in terms of access burden, stigma and disrupted trust. Their stated openness to non-opioid formats was hypothetical and conditional on affordability, reliable supply, credible efficacy, devotional compatibility and endorsement by a trusted clinician. Less stigmatising dispensing, explained dose reduction and a nurse-led continuity role are proposed as strategies requiring prospective evaluation.