RT Journal Article
SR Electronic
T1 Clustering of opioid prescribing and opioid-related mortality among family physicians in Ontario
JF Canadian Family Physician
JO Can Fam Physician
FD The College of Family Physicians of Canada
SP e92
OP e96
VO 57
IS 3
A1 Irfan A. Dhalla
A1 Muhammad M. Mamdani
A1 Tara Gomes
A1 David N. Juurlink
YR 2011
UL http://www.cfp.ca/content/57/3/e92.abstract
AB Objective To examine whether variation in prescribing at the level of the individual physician is associated with opioid-related mortality. Design A population-based cross-sectional analysis linking prescription data with records from the Office of the Chief Coroner. Setting The province of Ontario. Participants Family physicians in Ontario and Ontarians aged 15 to 64 who were eligible for prescription drug coverage under the Ontario Public Drug Program. Main outcome measures Variation in family physicians’ opioid prescribing and opioid-related mortality among their patients. Results The 20% of family physicians (n = 1978) who prescribed opioids most frequently issued opioid prescriptions 55 times more often than the 20% who prescribed opioids least frequently. Family physicians in the uppermost quintile also wrote the final opioid prescription before death for 62.7% of public drug plan beneficiaries whose deaths were related to opioids. Physician characteristics associated with greater opioid prescribing were male sex (P = .003), older age (P < .001), and a greater number of years in practice (P < .001). Conclusion Opioid prescribing varies remarkably among family physicians, and opioid-related deaths are concentrated among patients treated by physicians who prescribe opioids frequently. Strategies to reduce opioid-related harm should include efforts focusing on family physicians who prescribe opioids frequently.