"It's kind of a grey area and there's not very clear evidence around what you should do, so we use our own judgement. And there's a huge gulf between what one doctor thinks and another," Barnett explains.
Take, for example, a patient who comes to the emergency room complaining of back pain. There's evidence that opioids are not necessary in that situation, but many doctors prescribe them anyway, said Barnett. "The world of pain treatment outside of opioids is limited and can take time to figure out. Opioids are an easy fix."
The problem, he said, is that "even one prescription for opioids carries risks with it, that from my own experience as a provider, we tend to underestimate and under-explain to patients."
"It is very, very plausible that well-intentioned but perhaps overly aggressive prescribing of opioids makes it likely that a patient will continue a medication long-term even if they don't truly need it," said Dr. David Juurlink, a professor of medicine at the University of Toronto. He was not involved in the study. "The doctors in the lowest quartile are the ones whose prescribing we should seek to be emulating."