title: Effect of a course-based intervention and effect of medical regulation on physicians' opioid prescribing.
abstract: OBJECTIVE
  To examine the effects of an intensive 2-day course on physicians' prescribing of opioids.
  
  
  METHODS
  Population-based retrospective observational study.
  
  
  METHODS
  College of Physicians and Surgeons of Ontario (CPSO) in Toronto.
  
  
  METHODS
  Ontario physicians who took the course between April 1, 2000, and May 30, 2008.
  
  
  METHODS
  A 2-day opioid-prescribing course with a maximum of 12 physician participants. Educational methods included didactic presentations, case discussions, and standardized patients. A detailed syllabus and office materials were provided.
  
  
  METHODS
  Participants were matched with control physicians using specific variables. The primary outcome was the rate of opioid prescribing, expressed as milligrams of morphine equivalent per quarter.
  
  
  RESULTS
  One hundred thirty-eight course participants (120 family physicians, 15 specialists, and 3 physicians whose status was uncertain) were eligible for analysis. Of these, 68.1% were self-referred and 31.9% were referred by the CPSO. Overall, among physicians referred by the CPSO, the rate of opioid prescribing decreased dramatically in the year before course participation compared with matched control physicians. The course had no added effect on the rate of physicians' opioid prescribing in the subsequent 2 years. There was no statistically significant effect on the rate of opioid prescribing observed among the self-referred physicians. Among 15 of the self-referred physicians who, owing to the high quantities of opioids they prescribed, were not matched with control physicians, the rate of opioid prescribing decreased by 43.9% in the year following course completion.
  
  
  CONCLUSIONS
  Physicians markedly reduced the quantities of opioids they prescribed after medical regulators referred them to an opioid-prescribing course. The course itself did not lead to significant additional reductions; however, a subgroup of physicians who prescribed high quantities of opioids might have responded to what was taught in the course.
authors.affiliation: Department of Family and Community Medicine, University of Toronto (U of T), Ontario, Canada. meldon.kahan@wchospital.ca
authors.forename: Meldon
authors.initials: M
authors.lastname: Kahan
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
authors.forename: Michael
authors.initials: M
authors.lastname: Manno
authors.forename: Lynn
authors.initials: L
authors.lastname: Wilson
authors.forename: Angela
authors.initials: A
authors.lastname: Mailis-Gagnon
authors.forename: Anita
authors.initials: A
authors.lastname: Srivastava
authors.forename: Rhoda
authors.initials: R
authors.lastname: Reardon
authors.forename: Irfan A
authors.initials: IA
authors.lastname: Dhalla
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000592:standards*; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid