Effect of a course-based intervention and effect of medical regulation on physicians' opioid prescribing.

OBJECTIVE

To examine the effects of an intensive 2-day course on physicians' prescribing of opioids.

DESIGN

Population-based retrospective observational study.

SETTING

College of Physicians and Surgeons of Ontario (CPSO) in Toronto.

PARTICIPANTS

Ontario physicians who took the course between April 1, 2000, and May 30, 2008.

INTERVENTION

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.

MAIN OUTCOME MEASURES

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.

CONCLUSION

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.