During 2015-2017, physician knowledge was associated with less frequent prescribing of opioids for back pain, according to a study pub- lished in JAMA Network Open. Investigators compared the correlation of clinical knowledge with opioid prescribing from 2009-2011, when prescribing peaked nationally, with 2015-2017, when guidelines moved away from prescribing. A total of 10,246 midcareer US general internal medicine physicians were included in the study; clinical knowledge was measured by prior year American Board of Internal Medicine (ABIM) Maintenance of Certification examination per- formance. Data were included for 55,387 low back pain visits. The rates of opioid prescrib- ing were 21.6% and 17.6% for any opioid prescription and for high dosage or long dura- tion (HDLD) prescriptions, respectively. From 2009-2011, similar adjusted opioid prescribing rates were seen for visits with physicians in the highest and lowest knowledge quartiles, with a 0.5 percentage point difference. By 2015-2017, opioids were prescribed less frequently at visits with physicians in the highest versus the lowest knowledge quartile (4.6 percentage point differ- ence). Similar findings were observed for visits in which HDLD opioids were prescribed. “Physi- cians who performed well on an ABIM examina- tion assessing current knowledge were less likely to prescribe opioids for back pain than physi- cians who did not perform as well on the exam- ination,” the authors wrote.