Evaluating the intended and unintended consequences of opioid prescribing interventions on primary care

British Columbia (BC) has been hit particularly hard by the ongoing opioid overdose epidemic. In response, the province mobilized a variety of policy levers to encourage physicians to expand access to opioid agonist treatment (OAT) including adding variants of OAT to public benefits formularies, investing in physician training, and implementing two new fees to compensate physicians who provide treatment for opioid use disorder (OUD). Meanwhile, the College of Physicians and Surgeons of British Columbia (henceforth, 'the College') released the Safe Prescribing of Drugs with Potential for Misuse/Diversion practice standard which set enforceable thresholds for prescribing. Physicians found non-compliant with the new standard could be disciplined or fined. Policies aimed at expanding the provision of OAT may have positive spillover effects by expanding access to primary care physicians, thereby improving continuity and comprehensiveness of care. Meanwhile, for patients on opioid analgesics, the College's practice standard may have inadvertently restricted access to quality primary care. Given the magnitude of the opioid crisis, it is imperative to understand the consequences of changes to opioid prescribing on patients' access to quality health services. Our objective is to conduct a comprehensive investigation of the intended and unintended consequences of the changes to OAT prescribing and the College's practice standard for patients and physicians. This is a population-level, retrospective cohort study of all BC primary care physicians and their patients. Although the project uses BC data, many jurisdictions have implemented changes to prescribing in the context of the opioid epidemic, and we expect findings will be of international relevance.