Grant: Project Grant

Opioids are a complex issue. Prescription opioid addiction due to unsafe prescribing is associated with considerable harm and economic cost. If left untreated, the mortality rate is high. Though peer comparison letters, i.e. letters that aim to identify unsafe prescribing and motivate an individual physician to do something about it, have been shown to reduce injudicious prescribing for patients with chronic diseases, they have never been tested in people being initiated on opioids for pain. Among opioid nai¨ve patients being initiated on opioids for pain, previous work conducted by members of this team highlighted a dearth of valid ways to identify at-risk patients, importance of opioid sparring approaches to evidence based pain management, and significant beneficial effects of peer comparison letters (individualized prescribing portraits) on new prescribing for chronic conditions. In this trial, we will determine whether a 'complex' intervention that includes peer comparisons letter can reduce the proportion of new opioid prescriptions for people with pain. The time delayed trial is being conducted with family physicians in British Columbia and will involve distributing individualized prescribing portrait to all family physicians, practice visits and training of clinicians. The project is being conducted by experts responsible for research, planning and delivery of addiction treatment/primary care in Canada.