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 = .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.