Despite no evidence of long-term efficacy or safety, opioids are often recommended for non-cancer pain. Inappropriate opioid prescription treatments lack evidence. To evaluate opioid reduction obstacles and facilitators in a pharmacist-led primary care review and suggest review components and features for effective delivery by exploring the experiences of persons with chronic pain. UK primary care multi-method qualitative research. Semi-structured interviews (n = 15, 73% female) and an online discussion forum (n = 31) were conducted with opioid-using adults with chronic pain. The Theoretical Domains Framework (TDF) allowed data gathering and thematic analysis using deductive analysis to TDF domains, inductive analysis within domains to produce sub-themes, and sub-theme comparison to build across-domain themes. The behaviour change technique taxonomy (v1) and motivating behavior change technique categorization system were used to relate themes to behaviour change approaches to identify review components and delivery elements. 32 facilitator and barrier sub-themes for opioid-reducing patients were found across 13 TDF domains. These formed six themes: learning to live with pain, opioid reduction expectations, adopting a medical model, pharmacist-delivered evaluations, pharmacist–patient interaction, and patient participation. Sub-themes matched to 21 distinct behavior modification strategies, providing 17 components and five delivery features for the PROMPPT evaluation. This research provided theoretical support for a practice pharmacist-led PROMPPT evaluation. Future studies will evaluate PROMPPT review and pharmacist training feasibility and acceptance.