Learning that a patient had died by overdose may reduce the number and dose of opioid drugs clinicians prescribe, a cluster-randomized trial suggests.
Physicians who received a personal letter from a medical examiner notifying them of a recent patient's fatal overdose , reported Jason Doctor, MD, of the University of Southern California, and colleagues in Science.
"This finding could be very useful in the effort to reduce inappropriate prescribing of opioids without severely restricting availability of legally prescribed opioids for patients who should be getting them," National Institute on Aging Director Richard Hodes, MD, said in a statement.
"It shows that physicians respond to information about adverse outcomes. Behavioral 'nudges' like these letters could be a tool to help curb the opioid epidemic."
For this study, the researchers assessed 861 clinicians who had prescribed Schedule II, III, or IV drugs to 170 patients, all of whom died from overdose within a year of prescription in San Diego County from July 2015 to June 2016. Decedents were about 49 years old; about 80% were white and over 50% were men.
The intervention group (n=388) received a personal letter from the Chief Deputy Medical Examiner of San Diego County with the deceased patient's name, address, and age, and information about prescription drug deaths in their area and safe prescribing guidelines.
In the 3 months after the intervention, these clinicians reduced opioid prescribing by 9.7% (95% CI 6.2-13.2%; P<0.001). They also had fewer opioid-initiates and high-dose prescriptions.
The control group -- which did not receive letters -- did not change their opioid prescribing.
To date, traditional state regulatory approaches to reduce opioid prescribing have not achieved great success, Doctor and co-authors observed.
But this strategy may work: "People rely upon knowledge that is impactful, recent, and easy to retrieve from memory when judging probabilities and making decisions. Decisions to avoid harms could occur more frequently after receipt of the letter, because the effects of opioid harms are available to memory."
While these results may not apply to a larger population, the intervention is scalable at the county level, the researchers added.
Disclosures
The research was supported by the California Health Care Foundation and the National Institute on Aging at the National Institutes of Health.
The authors reported having no competing interests.
Primary Source
Science
Doctor J, et al "Opioid prescribing decreases after learning of a patient's fatal overdose" Science 2018; 361(6402): 588-590.