Quebec review finds 11 irregular prescribers after RAMQ flags opioid prescriptions
Quebec College probed hundreds flagged by RAMQ for opioid prescriptions; 11 doctors found with irregular practices and given corrective measures.
The Collège des médecins du Québec has reviewed hundreds of physicians identified by the Régie de l’assurance maladie du Québec (RAMQ) for high volumes of opioid prescriptions and concluded that 11 doctors showed irregular practices that could risk patient safety. The review, part of a program launched three years ago, used RAMQ prescribing data and risk criteria such as dosage and pill counts to target clinicians for inspection. While the College described a largely educational approach, the findings have prompted debate among clinicians and addiction specialists about whether the response is sufficiently robust. The issue sits against a backdrop of rising opioid-related deaths and a recent $22-million settlement with manufacturers and distributors.
RAMQ data triggered a broad screening
The RAMQ database identified roughly 2,000 physicians whose prescribing patterns met the College’s risk criteria, the regulator and the College say. Those criteria considered total dose, pill counts and frequency, aiming to detect outlier prescribing that could contribute to diversion or dependence. From that pool, the College selected a smaller group for follow-up to balance the scope of the inquiry with investigative resources.
The screening was designed to separate occasional high-prescribing events from repeated patterns, the College said, allowing inspectors to prioritise cases most likely to reflect persistent practice issues. The data-driven phase is central to the program and is intended to flag potential problems while minimising unwarranted intrusion into legitimate clinical care.
Inspections narrowed focus to 26 physicians
College inspectors summoned 26 physicians for detailed review interviews after an initial analysis of prescriptions flagged by RAMQ. Each interview examined clinical records, the medical rationale for prescriptions and the context in which opioids and benzodiazepines were prescribed. Inspectors aimed to determine whether high volumes reflected specialist care in pain or addiction treatment, legitimate complex cases, or practices that required correction.
Following those interviews, the College concluded that 11 physicians had practices “outside the norm” that posed potential risks to patients. The remaining 15 were judged not to present a problem, and the College said further meetings remain scheduled as the inquiry continues.
Corrections and educational measures recommended
The Collège des médecins said the 11 physicians received letters outlining specific recommendations to modify prescribing practices. Measures included reminders about drug interactions, guidance on prescribing naloxone kits where appropriate, and strongly suggested continuing education in pain management and addiction medicine. The College emphasised a pedagogical approach, prioritising remediation and support rather than immediate punitive action.
Inspectors also encouraged clinicians to adopt safer prescribing tools and to consider non-opioid alternatives when clinically indicated. The College framed these steps as intended to protect patients while preserving access to necessary pain care.
Specialists say findings may understate the problem
Some clinicians working in mental health and addiction expressed scepticism that only 11 prescribers were identified as problematic after RAMQ flagged hundreds. Family physician Marie-Ève Morin, who treats patients with dependence and mental-health needs, said she was surprised by the small number of cases classified as irregular. She questioned which thresholds and contextual factors were applied by the RAMQ and the College during the selection and review process.
Morin also warned that clinics specialising in pain or addiction can legitimately prescribe larger supplies of controlled medications, but that does not eliminate the potential for inappropriate or risky prescribing in some settings. Her comments reflect wider unease among some clinicians about whether regulatory reviews capture the full scope of prescribing behaviours that contribute to harm.
Rising toll and legal settlements underline urgency
Public-health data underscore the stakes of opioid prescribing. The Institut national de santé publique du Québec (INSPQ) reported a 33 percent increase in suspected opioid-related deaths by December 2024 compared with the same period in 2023. Between April 2025 and March 2026, the INSPQ recorded 596 deaths linked to suspected opioid or other drug intoxications. Those numbers frame the regulatory effort within an ongoing overdose crisis affecting communities across the province.
At the same time, a recent class-action settlement requires opioid manufacturers and distributors to provide $22 million in compensation to individuals who developed dependence following prescription use. Authorities now face the practical challenge of identifying and notifying eligible recipients and ensuring compensation reaches those affected.
The College noted that current prescribing patterns are very different from the major excesses seen a decade ago, crediting increased physician awareness and monitoring for preventing large-scale "derailments" of practice. Still, officials cautioned that vigilance must continue.
The College’s inspectors will continue their work, meeting a further 12 members identified through the RAMQ screening, and the program will keep combining data analysis with targeted inspections and educational follow-up. The balance the regulator seeks — between safeguarding patients and supporting clinicians who treat complex pain and addiction — will remain central as Quebec confronts the twin challenges of preventing diversion and ensuring appropriate access to care.
Public-health officials and professional bodies say more surveillance, clinician training and patient supports, including naloxone distribution and addiction treatment access, are essential to reduce harms while maintaining necessary pain management options.
