title: Clustering of opioid prescribing and opioid-related mortality among family physicians in Ontario.
abstract: OBJECTIVE
  To examine whether variation in prescribing at the level of the individual physician is associated with opioid-related mortality.
  
  
  METHODS
  A population-based cross-sectional analysis linking prescription data with records from the Office of the Chief Coroner.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ont. dhallai@smh.ca
authors.forename: Irfan A
authors.initials: IA
authors.lastname: Dhalla
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D062787:Drug Overdose / Q000401:mortality; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009864:Ontario / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055553:Prescription Drugs / Q000506:poisoning* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs