Clustering of opioid prescribing and opioid-related mortality among family physicians in Ontario

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 = 0.003), older age (P < 0.001), and a greater number of years in practice (P < 0.001).

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.