title: Survey of Ontario primary care physicians' experiences with opioid prescribing.
abstract: OBJECTIVE
  To measure physicians' experiences with opioid-related adverse events and their perceived level of confidence in their opioid prescribing skills and practices.
  
  
  METHODS
  Mailed survey. Setting The province of Ontario.
  
  
  METHODS
  A total of 1000 primary care physicians randomly selected from the College of Physicians and Surgeons of Ontario registration database.
  
  
  METHODS
  Opioid-related adverse events and concerns (eg, number of patients, type of opioid, cause of the event or concern); physicians' confidence, comfort, and satisfaction with opioid prescribing; physicians' opinions on strategies to optimize their prescribing; and physicians' perspectives of their interactions with pharmacists and nurses.
  
  
  RESULTS
  The response rate was close to 66%, for a total of 658 participants. Almost all respondents reported prescribing opioids for chronic pain in the past 3 months. Eighty-six percent of respondents reported being confident in their prescribing of opioids, but 42% of respondents indicated that at least 1 patient had experienced an adverse event related to opioids in the past year, usually involving oxycodone, and 16.3% of respondents did not know if their patients had experienced any opioid-related adverse events. The most commonly cited factors leading to adverse events were that the patient took more than prescribed, the prescribed dose was too high, or the patient took alcohol or sedating drugs with the opioids. Most physicians had concerns about the opioid use of 1 or more of their patients; concerns included running out of opioids early, minimal access to pain and addiction treatment, and addiction and overdose. The reported number of physicians' patients taking opioids was positively associated with their confidence and comfort levels in opioid prescribing and negatively associated with their belief that many patients become addicted to opioids.
  
  
  CONCLUSIONS
  Most physicians have encountered opioid-related adverse events. Comprehensive strategies are required to promote safe prescribing of opioids, including guidelines and comprehensive office-system materials.
authors.affiliation: Laurentian University, School of Rural and Northern Health, Sudbury, ON P3E 2C6, Canada. ewenghofer@laurentian.ca
authors.forename: Elizabeth Francis
authors.initials: EF
authors.lastname: Wenghofer
authors.forename: Lynn
authors.initials: L
authors.lastname: Wilson
authors.forename: Meldon
authors.initials: M
authors.lastname: Kahan
authors.forename: Carolynn
authors.initials: C
authors.lastname: Sheehan
authors.forename: Anita
authors.initials: A
authors.lastname: Srivastava
authors.forename: Ava
authors.initials: A
authors.lastname: Rubin
authors.forename: Joanne
authors.initials: J
authors.lastname: Brathwaite
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D002983:Clinical Competence; D003625:Data Collection; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010146:Pain / Q000188:drug therapy*; D010595:Pharmacists; D019555:Physician-Nurse Relations; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians'
chemical_list: D000701:Analgesics, Opioid