The opioid epidemic is currently one of the most pressing patient safety challenges, as discussed in a recent Annual Perspective. High-risk prescribing practices by clinicians is one contributing factor in the surge in opioid use among patients. Prior research has shown that patients often receive opioids following low-risk procedures, and they frequently receive opioid prescriptions even after overdosing on these medications. This cohort study found wide variations in opioid prescribing practices among emergency departments, with some physicians prescribing opioids almost three times as often even after controlling for patient characteristics. Notably, patients who received opioids from a high-intensity prescriber were significantly more likely to continue using opioids 12 months later—indicating a possible connection between physician prescribing practices and subsequent opioid addiction. The study confirms that reducing variation in physician prescribing practices should be one component of an overall strategy to address opioid overuse.