BACKGROUND:Limited empirical evidence informs fitness-to-drive recommendations after implantable cardioverter-defibrillator (ICD) implantation. Cohort designs can be deceptive because ICD recipients differ from control individuals and may temporarily cease driving after implantation. OBJECTIVES:This study sought to generate evidence to inform medical driving restrictions after ICD implantation. METHODS:We used population-based data to identify all drivers involved in a serious motor vehicle crash in British Columbia, Canada, from 1997 to 2019. Exposure was defined as ICD implantation in the 6 months before a crash. One analysis used a case-crossover design to control for relatively fixed individual characteristics like driving experience. Another analysis used a responsibility design to account for road exposure (miles of driving per week). Both analyses used logistic regression with adjustment for potential confounders. RESULTS:In the case-crossover analysis of crash-involved ICD recipients, ICD implantation occurred in 212 of 3,299 precrash intervals and in 485 of 6,598 control intervals, suggesting no temporal association between ICD implantation and subsequent crash (6.4% vs 7.4%; adjusted OR [aOR]: 0.86; 95% CI: 0.71-1.03; P = 0.11). In the analysis of all crash-involved drivers with determinate crash responsibility, 14 of 22 drivers with recent ICD implantation and 532,741 of 1,035,433 drivers without recent ICD implantation were deemed responsible for their crash, suggesting no association between ICD implantation and crash responsibility (crude proportion responsible, 64% vs 51%; aOR: 2.20; 95% CI: 0.94-5.30; P = 0.08). CONCLUSIONS:The 6-month interval after ICD implantation is not associated with increased odds of crash nor with increased likelihood of crash responsibility. Contemporary driving restrictions in the first weeks after ICD implantation appear to adequately mitigate the potential increase in crash risk.

Objective To describe family physicians who primarily practise in a walk-in clinic setting and compare them with family physicians who provide longitudinal care. Design A cross-sectional study that linked results from a 2019 physician survey to provincial administrative health care data in Ontario. The characteristics, practice patterns, and patients of physicians primarily working in a walk-in clinic setting were compared with those of family physicians providing longitudinal care. Setting Ontario. Participants Physicians who primarily worked in a walk-in clinic setting in 2019, as indicated by an annual physician survey. Main outcome measures Physician demographic and practice characteristics, as well as their patients' demographic and health care utilization characteristics, were reported according to whether the physician was a walk-in clinic physician or a family physician who provided longitudinal care. Results Compared with the 9137 family physicians providing longitudinal care, the 597 physicians who self-identified as practising primarily in walk-in clinics were more frequently male (67% vs 49%) and more likely to speak a language other than English or French (43% vs 32%). Walk-in clinic physicians tended to have more encounters with patients who were younger (mean 37 vs 47 years), who had lower levels of prior health care utilization (15% vs 19% in highest band), who resided in large urban areas (87% vs 77%), and who lived in highly ethnically diverse neighbourhoods (45% vs 35%). Walkin clinic physicians tended to have more encounters with unattached patients (33% vs 17%) and with patients attached to another physician outside their group (54% vs 18%). Conclusion Physicians who primarily work in walk-in clinics saw many patients from historically underserved groups and many patients who were attached to another family physician.

Background Among individuals with recent syncope, recurrence of syncope while driving might incapacitate a driver and cause a motor vehicle crash. Current driving restrictions assume that some forms of syncope transiently increase crash risk. We evaluated whether syncope is associated with a transient increase in crash risk. Methods We performed a case-crossover analysis of linked administrative health and driving data from British Columbia, Canada (2010 to 2015). We included licensed drivers who visited an emergency department with "syncope and collapse" and who were involved as a driver in an eligible motor vehicle crash, both within the study interval. Using conditional logistic regression, we compared the rate of emergency visits for syncope in the 28 days before crash (the "pre-crash interval") with the rate of emergency visits for syncope in 3 self-matched 28-day control intervals (ending 6, 12, and 18 months before the crash). Results Among eligible crash-involved drivers, 47 of 3026 pre-crash intervals and 112 of 9078 control intervals had emergency visits for syncope, indicating syncope was not significantly associated with subsequent crash (1.6% vs 1.2%; adjusted odds ratio [OR], 1.27; 95% confidence interval [CI], 0.90-1.79; P = 0.18). There was no significant association between syncope and crash in subgroups at higher risk for adverse outcomes after syncope (eg, age > 65 years, cardiovascular disease, cardiac syncope). Conclusions In the context of prevailing modifications of driving behaviour after syncope, an emergency department visit for syncope did not transiently increase the risk of subsequent traffic collision. Overall crash risks after syncope appear to be adequately addressed by current driving restrictions.

Objectives:Several opioid prescribing initiatives have been recently evaluated including the Portrait letter program in British Columbia (BC). The experiences of primary care providers targeted by these programs have not been fully characterized. This qualitative study sought to examine barriers and facilitators to implementing prescribing Portraits with educational webinars on pain management with opioids in primary care.Methods:This study involved qualitative analysis of focus groups conducted for a mixed-method, randomized trial of an opioid prescribing feedback intervention (REDONNA). Participants were recruited following an educational webinar from primary care settings. As part of REDONNA's qualitative arm, 19 family physicians, 13 nurse practitioners, and 3 other professionals participated in focus groups. The data were analyzed in the light of the Consolidated Framework for Implementation Research.Results:The Consolidated Framework for Implementation Research highlighted 4 topics represented by 12 subtopics: 4 structural, 3 organizational, 2 individual, and 3 interventional factors. Participants identified that their decision-making for opioid prescribing was influenced not only by the intended educational messages but also by their experiences with people who had opioid use disorders (PWOUD). Spending time with patients, supportive working environments, tailoring Portraits, and accessing expertise facilitated implementation. Suggested improvements included more funding for nonpharmacological alternatives and more in-depth stratified data.Conclusions:Prescribing feedback programs should move beyond opioid-sparing approaches to better address the challenges experienced by marginalized populations. Appropriate understanding of and sensibility toward PWOUD appears to benefit the meaningful implementation of opioid training programs in primary care. Objectifs:Plusieurs initiatives de prescription d'opio & iuml;des ont & eacute;t & eacute; r & eacute;cemment & eacute;valu & eacute;es, y compris le programme Portrait Letter en Colombie-Britannique (C.-B.). Les exp & eacute;riences des fournisseurs de soins primaires cibl & eacute;s par ces programmes n'ont pas & eacute;t & eacute; enti & egrave;rement caract & eacute;ris & eacute;es. Cette & eacute;tude qualitative visait & agrave; examiner les obstacles et les facilitateurs & agrave; la mise en oe uvre de Portraits de prescription avec des webinaires & eacute;ducatifs sur la gestion de la douleur avec des opio & iuml;des dans les soins primaires.M & eacute;thodes:Cette & eacute;tude a consist & eacute; en une analyse qualitative de groupes de discussion organis & eacute;s dans le cadre d'un essai randomis & eacute; & agrave; m & eacute;thode mixte portant sur une intervention de r & eacute;troaction en mati & egrave;re de prescription d'opio & iuml;des (REDONNA). Les participants ont & eacute;t & eacute; recrut & eacute;s & agrave; la suite d'un webinaire & eacute;ducatif dans des & eacute;tablissements de soins primaires. Dans le cadre du volet qualitatif de REDONNA, 19 m & eacute;decins de famille, 13 infirmier(e)s praticien(ne)s et trois autres professionnel(le)s ont particip & eacute; & agrave; des groupes de discussion. Les donn & eacute;es ont & eacute;t & eacute; analys & eacute;es & agrave; la lumi & egrave;re du cadre du groupe The Consolidated Framework for Implementation Research (CFIR).R & eacute;sultats:Le CFIR a mis en & eacute;vidence quatre th & egrave;mes principaux repr & eacute;sent & eacute;s par 12 sous-th & egrave;mes : quatre facteurs structurels, trois facteurs organisationnels, deux facteurs individuels et trois facteurs interventionnels. Les participants ont indiqu & eacute; que leur prise de d & eacute;cision concernant la prescription d'opio & iuml;des & eacute;tait influenc & eacute;e non seulement par les messages & eacute;ducatifs pr & eacute;vus, mais aussi par leurs exp & eacute;riences avec des personnes souffrant de troubles li & eacute;s & agrave; l'utilisation d'opio & iuml;des (PSTUO). Le fait de passer du temps avec les patients, des environnements de travail favorables, l'adaptation des Portraits et l'acc & egrave;s & agrave; l'expertise ont facilit & eacute; la mise en oe uvre. Parmi les am & eacute;liorations sugg & eacute;r & eacute;es, citons un financement accru des alternatives non pharmacologiques et des donn & eacute;es stratifi & eacute;es plus approfondies.Conclusions:Les programmes de r & eacute;troaction en mati & egrave;re de prescription devraient aller au-del & agrave; des approches d'& eacute;conomie d'opio & iuml;des afin de mieux r & eacute;pondre aux d & eacute;fis auxquels sont confront & eacute;es les populations marginalis & eacute;es. Une bonne compr & eacute;hension et une sensibilit & eacute; & agrave; l'& eacute;gard de la PSTUO semblent favoriser une mise en oe uvre significative des programmes de formation sur les opio & iuml;des dans le cadre des soins primaires.

ObjectiveTo evaluate the impact of a personalised audit and feedback prescribing report (AF) and brief educational summary (ES) on empiric treatment of uncomplicated lower urinary tract infections (UTIs) by family physicians (FPs).DesignCluster randomised control trial.SettingThe intervention was conducted in British Columbia, Canada between 23 September 2021 and 28 March 2022.ParticipantsWe randomised 5073 FPs into a standard AF and ES intervention arm (n=1691), an ES-only arm (n=1691) and a control arm (n=1691).InterventionsThe AF contained personalised and peer-comparison data on first-line antibiotic prescriptions for women with uncomplicated lower UTI and key therapeutic recommendations. The ES contained detailed, evidence-based UTI management recommendations, incorporated regional antibiotic resistance data and recommended nitrofurantoin as a first-line treatment.Main outcome measuresNitrofurantoin as first-line pharmacological treatment for uncomplicated lower UTI, analysed using an intention-to-treat approach.ResultsWe identified 21 307 cases of uncomplicated lower UTI among the three trial arms during the study period. The impact of receiving both the AF and ES increased the relative probability of prescribing nitrofurantoin as first-line treatment for uncomplicated lower UTI by 28% (OR 1.28; 95% CI 1.07 to 1.52), relative to the delay arm. This translates to additional prescribing of nitrofurantoin as first-line treatment, instead of alternates, in an additional 8.7 cases of uncomplicated UTI per 100 FPs during the 6-month study period.ConclusionAF prescribing data with educational materials can improve primary care prescribing of antibiotics for uncomplicated lower UTI.Trial registration numberNCT05817253.

Objectives The South Peace Polypharmacy Reduction Project is a quality improvement project in three communities in rural Canada that aimed to reduce polypharmacy and inappropriate prescribing practices in older adults. This study aims to evaluate the impact of a multifaceted intervention consisting of online team-based medication reviews and educational workshops on the number of chronic medications. Methods A controlled before-after design was used to compare if a decrease in the number of chronic medications was associated with the intervention comprising of online team-based medication reviews and educational workshops, compared with two matched control groups that received either a standard medication review or no medication review. Logistic regression models fit with generalized estimated equations were used to identify the impact of the interventions on decreasing the number of chronic medications. Key findings Following a medication review, the percentage of individuals that had deprescribed at least one medication was highest in the intervention group (52%), followed by the medication review controls at 45%, and 36% in non-medication review controls. Individuals in the intervention group were 20% more likely to have at least one medication deprescribed than individuals in the medication review control group (adjusted odds ratio: 1.20; 95% CI: 1.03 to 1.39), whereas they were 42% more likely to deprescribe at least one medication compared with non-medication review controls (adjusted odds ratio: 1.42; 95% CI: 1.25 to 1.61). Conclusions Online team-based medication reviews had a significant impact on decreasing the number of chronic medications in older adults. Furthermore, providing healthcare providers with education can complement the role of other healthcare interventions.

Objective To evaluate the impact of personalized prescribing portraits on antibiotic prescribing for treating uncomplicated acute cystitis (UAC) by Family Physicians (FPs). Design Cluster randomized control trial. Setting The intervention was conducted in the primary care setting in the province of BC between December 2010 and February 2012. Participants We randomized 4 833 FPs by geographic location into an Early intervention arm (n = 2 417) and a Delayed control arm (n = 2 416). Intervention The Education for Quality Improvement in Patient Care (EQIP) program mailed to each FP in BC, a ‘portrait’ of their individual prescribing of antibiotics to women with UAC, plus therapeutic recommendations and a chart of trends in antibiotic resistance. Main outcome measures Antibiotic prescribing preference to treat UAC. Results Implementing exclusion criteria before and after a data system change in the Ministry of Health caused the arms to be unequal in size–intervention arm (1 026 FPs, 17 637 UAC cases); control arm (1 352 FPs, 25 566 UAC cases)–but they were well balanced by age, sex and prior rates of prescribing antibiotics for UAC. In the early intervention group probability of prescribing nitrofurantoin increased from 28% in 2010 to 38% in 2011, a difference of 9.9% (95% confidence interval [CI], 9.1% to 10.7. Ciprofloxacin decreased by 6.2% (95% CI: 5.6% to 6.9%) and TMP-SMX by 3.7% (95% CI: 3.1% to 4.2%). Among 295 FPs who completed reflective surveys, 52% said they were surprized by the E. coli resistance statistics and 57% said they planned to change their treatment of UAC. Conclusion The EQIP intervention demonstrated that feedback of personal data to FPs on their prescribing, plus population data on antibiotic resistance, with a simple therapeutic recommendation, can significantly improve prescribing of antibiotics. Trial registration: ISRCTN 16938907.

Walk-in clinics are typically viewed as high-volume locations for managing acute issues but also may serve as a location for primary care, including cancer screening, for patients without a family physician. In this population-based cohort study, we compared breast, cervical and colorectal cancer screening up-to-date status for people living in the Canadian province of Ontario who were formally enrolled to a family physician versus those not enrolled but who had at least one encounter with a walk-in clinic physician in the previous year. Using provincial administrative databases, we created two mutually exclusive groups: i) those who were formally enrolled to a family physician, ii) those who were not enrolled but had at least one visit with a walk-in clinic physician from April 1, 2019 to March 31, 2020. We compared up to date status for three cancer screenings as of April 1, 2020 among screen-eligible people. We found that people who were not enrolled and had seen a walk-in clinic physician in the previous year consistently were less likely to be up to date on cancer screening than Ontarians who were formally enrolled with a family physician (46.1% vs. 67.4% for breast, 45.8% vs. 67.4% for cervical, 49.5% vs. 73.1% for colorectal). They were also more likely to be foreign-born and to live in structurally marginalized neighbourhoods. New methods are needed to enable screening for people who are reliant on walk-in clinics and to address the urgent need in Ontario for more primary care providers who deliver comprehensive, longitudinal care.

Background: Exposure to opioid analgesics have historically raised concern for a risk of developing opioid use disorder. Prescriber audit-and-feedback interventions may reduce opioid prescribing, but some studies have shown detrimental effects for current users. We examined the effectiveness of an audit and feedback intervention, named Portrait, to reduce initiation of opioid analgesics among opioid-naive patients experiencing pain. Methods: REDONNA was a single-blinded, two-arm (Early vs Delayed mailing) randomized trial of a portrait for eligible family physicians (FPs) in British Columbia (BC), Canada. The primary outcome was the change in the number of initiations of opioid analgesic prescriptions written by FPs for acute/chronic pain management. We compared outcomes for a 6-month window before vs. after each mailed intervention, using differences in percent differences (DPD) with 95% confidence intervals (CI) and odds ratios (OR) from logistic regressions adjusted for clustering of patients by FP. Results: In the Early (n = 2260) and Delayed (n = 2156) groups, opioid initiations per month were the same in the Before (2.10 Early; 2.06 Delayed) and After (1.94 Early; 1.95 Delayed) windows. The DPD was -2.1% (CI: -4.4% to 0.3%), and ORs were: 0.98 (CI: 0.96 to 1.01) for any opioid, 0.97 (CI: 0.94 to 1.01) for codeine (62% of initiations), and 1.0 (CI: 0.97 to 1.07) for tramadol (25% of initiations). There were no differences in mean quantity of tablets, mean milligrams of morphine equivalents (MME), or mean number of days. Conclusion: Portrait had no impact on FPs' rates of prescribing opioid analgesics to opioid-naive patients experiencing pain. Trial registration: The study was registered prospectively on 30 March 2020 at the ISRCTN Register (https://www. isrctn.com/ISRCTN34246811).

ABSTRACT Purpose As deaths from the illicit drug poisoning crisis continue to rise in Canada, increasing the number of healthcare professionals qualified to effectively prescribe opioids could be beneficial. The willingness of family medicine residents to undertake structured training in prescribing opioids for Opioid Agonist Treatment (OAT) and pain management have not been well described. Materials and methods Family medicine residents (n = 20) in British Columbia, Canada, were asked about their experience with and willingness to enrol in OAT training. Informed by the Consolidated Framework for Implementation Research, data were analysed thematically using NVivo software. Results Four themes were identified: (1) challenges to training implementation, (2) feelings and attitudes on prescribing practices, (3) helpful learning spaces and places of substance use training, and (4) recommendations for implementing training. Preparedness, exposure, and supportive learning environments for substance use education increased willingness to pursue OAT accreditation, while ineffective learning experiences, mixed feelings about opioid prescribing, and lack of protected time were the most common reasons for unwillingness. Conclusions Protected time and a range of clinical experiences appear to facilitate residents’ willingness to complete OAT and opioid training. Implementation strategies to enhance the uptake of OAT accreditation in family medicine residency must be prioritised.

BACKGROUND:Instrumental variable (IV) analysis provides an alternative set of identification assumptions in the presence of uncontrolled confounding when attempting to estimate causal effects. Our objective was to evaluate the suitability of measures of prescriber preference and calendar time as potential IVs to evaluate the comparative effectiveness of buprenorphine/naloxone versus methadone for treatment of opioid use disorder (OUD). METHODS:Using linked population-level health administrative data, we constructed five IVs: prescribing preference at the individual, facility, and region levels (continuous and categorical variables), calendar time, and a binary prescriber's preference IV in analyzing the treatment assignment-treatment discontinuation association using both incident-user and prevalent-new-user designs. Using published guidelines, we assessed and compared each IV according to the four assumptions for IVs, employing both empirical assessment and content expertise. We evaluated the robustness of results using sensitivity analyses. RESULTS:The study sample included 35,904 incident users (43.3% on buprenorphine/naloxone) initiated on opioid agonist treatment by 1585 prescribers during the study period. While all candidate IVs were strong (A1) according to conventional criteria, by expert opinion, we found no evidence against assumptions of exclusion (A2), independence (A3), monotonicity (A4a), and homogeneity (A4b) for prescribing preference-based IV. Some criteria were violated for the calendar time-based IV. We determined that preference in provider-level prescribing, measured on a continuous scale, was the most suitable IV for comparative effectiveness of buprenorphine/naloxone and methadone for the treatment of OUD. CONCLUSIONS:Our results suggest that prescriber's preference measures are suitable IVs in comparative effectiveness studies of treatment for OUD.

INTRODUCTION:Urine drug tests (UDTs) are commonly used for monitoring opioid agonist treatment (OAT) responses, supporting the clinical decision for take-home doses and monitoring potential diversion. However, there is limited evidence supporting the utility of mandatory UDTs-particularly the impact of UDT frequency on OAT retention. Real-world evidence can inform patient-centred approaches to OAT and improve current strategies to address the ongoing opioid public health emergency. Our objective is to determine the safety and comparative effectiveness of alternative UDT monitoring strategies as observed in clinical practice among OAT clients in British Columbia, Canada from 2010 to 2020. METHODS AND ANALYSIS:We propose a population-level retrospective cohort study of all individuals 18 years of age or older who initiated OAT from 1 January 2010 to 17 March 2020. The study will draw on eight linked health administrative databases from British Columbia. Our primary outcomes include OAT discontinuation and all-cause mortality. To determine the effectiveness of the intervention, we will emulate a 'per-protocol' target trial using a clone censoring approach to compare fixed and dynamic UDT monitoring strategies. A range of sensitivity analyses will be executed to determine the robustness of our results. ETHICS AND DISSEMINATION:The protocol, cohort creation and analysis plan have been classified and approved as a quality improvement initiative by Providence Health Care Research Ethics Board and the Simon Fraser University Office of Research Ethics. Results will be disseminated to local advocacy groups and decision-makers, national and international clinical guideline developers, presented at international conferences and published in peer-reviewed journals electronically and in print.

Background: Walk-in clinics are common in North America and are designed to provide acute episodic care without an appointment. We sought to describe a sample of walk-in clinic patients in Ontario, Canada, which is a setting with high levels of primary care attachment. Methods: We performed a cross-sectional study using health administrative data from 2019. We compared the sociodemographic characteristics and health care utilization patterns of patients attending 1 of 72 walk-in clinics with those of the general Ontario population. We examined the subset of patients who were enrolled with a family physician and compared walk-in clinic visits to family physician visits. Results: Our study found that 562 781 patients made 1 148 151 visits to the included walk-in clinics. Most (70%) patients who attended a walk-in clinic had an enrolling family physician. Walk-in clinic patients were younger (mean age 36 yr v. 41 yr, standardized mean difference [SMD] 0.24), yet had greater health care utilization (moderate and high use group 74% v. 65%, SMD 0.20) than the general Ontario population. Among enrolled Ontarians, walk-in patients had more comorbidities (moderate and high count 50% v. 45%, SMD 0.10), lived farther from their enrolling physician (median 8 km v. 6 km, SMD 0.21) and saw their enrolling physician less in the previous year (any visit 67% v. 80%, SMD 0.30). Walk-in encounters happened more often after hours (16% v. 9%, SMD 0.20) and on weekends (18% v. 5%, SMD 0.45). Walk-in clinics were more often within 3 km of patients’ homes than enrolling physicians’ offices (0 to < 3 km: 32% v. 22%, SMD 0.21). Interpretation: Our findings suggest that proximity of walk-in clinics and after-hours access may be contributing to walk-in clinic use among patients enrolled with a family physician. These findings have implications for policy development to improve the integration of walk-in clinics and longitudinal primary care.

( Can J Anesth/J Can Anesth. 2022;69:997–1006) Opioids have been overprescribed in North America, including in the field of obstetrics, over the past two decades. Cesarean delivery (CD) is the most common inpatient surgery performed in Canada and opioids are commonly prescribed at discharge to post-CD patients. In 2008, a warning was issued by Health Canada against the use of codeine in mothers who were breastfeeding. A recent study based in the United States found that opioid prescribing practices varied most by the hospital, rather than current recommendations or patient factors. This study used the Surgical Quality Outcome Reports (SQOR) study and the SQOR Extension Study to identify post-CD prescribing patterns among hospitals, hospital type, and hospital location, to inform quality improvement efforts.

Objectives: Educational interventions to increase opioid-sparing prescriptions have been promoted in North America, however some results suggest that this subject has not been adequately explained to nurses and family physicians. There have been reports of unintended consequences due to premature discontinuation and poor integration of opioid sparing into practice which has impeded pain management and opioid care. Several audit, feedback and training initiatives have recently emerged internationally, including the Portrait program in British Columbia (BC), Canada. We conducted a qualitative evaluation to examine barriers and enablers to implementing individualized Portraits to support sparing opioid prescriptions to opioid naïve patients.Methods: This study involved thematic analysis of focus groups conducted as part of a mixed-method, randomized trial of opioid audit and feedback intervention versus delayed intervention for family physicians (REDONNA). Participants were recruited following an educational webinar from community settings across BC. As part of the qualitative component of the primary trial, 13 nurse practitioners, 19 family physicians and three other health professionals participated in focus groups. Focus groups solicited participant experiences with and attitudes towards opioid audit and feedback programs in primary care, in the light of the Consolidated Framework for Implementation Research (CFIR).Results: CFIR highlighted four domains represented by 12 sub-themes: four structural, three organizational, two individual, and three interventional factors. Participants identified that their decision-making for opioid-sparing prescribing to opioid-naïve people is influenced not only by the intended educational messages but also by their experiences with people with opioid use disorder (PWOUD). Participants recommended that spending time with patients, supportive working environments, tailored Portraits and accessing expertise fostered implementation.Conclusions: Implementation of opioid audit and feedback programs requires appropriate understanding of and sensibility towards PWOUD. Research into the factors that shape the delivery of opioid audit and feedback to ensure equitable prescribing to marginalized populations (i.e., PWOUD) is a priority.

Postdischarge opioid prescriptions are reportedly much higher in Canada than in other countries. To assess potentially contributing factors, we examined trends after abdominal and orthopedic surgeries in British Columbia (BC). Using the BC Ministry of Health’s databases on physician billings, hospital discharge abstracts, and medication dispensations in community pharmacies for the period 2003–2016, we assembled a cohort of 263,056 patients who received laparoscopic appendectomy (LA, 11%), laparoscopic cholecystectomy (LC, 30%), open inguinal or femoral hernia repair (IHR, 20%), total hip arthroplasty (THA, 18%), or total knee arthroplasty (TKA, 22%). Adjusting for covariates using generalized linear modeling, we measured trends in percentages of patients dispensed opioids postdischarge (opioid rate) within 30 days after surgery, by surgery type, opioid type, prior use, surgeon, and trends in morphine milligram equivalents of first dispensations (MME) with 95% confidence intervals (CI). Opioid dispensation rates rose steadily. Mean annual increases were 1.7% in LA; 1.3% in LC; 0.8% in IHR; 0.9% in THA; and 0.8% in TKA. By 2016, rates were 69% in LA; 76% in LC; 81% in IHR; 88% in THA; and 94% in TKA. Codeine dispensations fell 2.4% (abdominal) and 3.1% (orthopedic) per year while tramadol dispensations increased 3.6% (abdominal) and 1.7% (orthopedic). Hydromorphone dispensations increased 2.9% per year (orthopedic); oxycodone was level at 22% between 2007 and 2014, but then fell. The mean MME rose 8 mg⋅yr-1 (95% CI, 7 to 9) (abdominal) and 61 mg⋅yr-1 (95% CI, 58 to 64) (orthopedic). Variation in rates was greater among abdominal than orthopedic surgeons. Rising opioid dispensation rates, together with shifts to prescribing higher MME opioids, doubled MME per patient in first dispensations postdischarge after abdominal or orthopedic surgery from 2003 to 2016 in BC.