A letter from a medical examiner to a physician notifying them of a recent patient's fatal overdose due to opioids may help inspire safer prescribing habits, a new San Diego-based study says. The research addresses an under-recognized factor in the mounting opioid crisis - unwarranted prescriptions that set people on an initial path towards addiction. Most people who suffer fatal consequences of opioid addiction do so after being legally prescribed the drug for common ailments. In most cases the risk of opioid use greatly outweighs the benefits; however, relatively few efforts have sought to counter the factors that promote the high rate of opioid prescriptions putting patients at undue risk. Possibly among these factors is the fact that often, clinicians do not know about overdose deaths among their patients. Here, in a study based at San Diego County clinics, Jason Doctor and colleagues evaluated if or how physicians' prescription behavior changed after these individuals learned about fatalities of patients in their practices. The authors conducted a controlled randomized trial of 861 clinicians who prescribed opioids to 170 persons, all of whom ultimately suffered a fatal overdose within a year of prescription. Clinicians were split into two groups: a control group and an intervention group. Those in the latter group received a personal letter from the county's chief medical examiner identifying their decedent patient's name, address and age, as well as information regarding prescription drug deaths in their area. The letter also reiterated state and federal safe prescribing guidelines. According to Doctor et al., the feedback in the letter resulted in a 9.7% reduction of opioids prescribed by physicians who received such letters, as evaluated over three months following letter receipt. Among letter recipients, the authors also observed other changes; namely, reductions in opioid-initiates and high-dose prescriptions. In contrast, in the control group, who received no letters, opioid prescriptions remained unchanged. Whereas other regulatory attempts to limit opioid prescribing have not been as successful, the authors suggest that the impactful information the letters contain carry a particular weight, which encourages cautious opioid prescribing by physicians.
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Journal
Science