Letting Doctors Know a Patient Has Overdosed Might Curb Opioid Overprescribing
One low-cost intervention could make a difference in America's epidemic of opioid overdoses, a new study suggests.
When health care providers were notified that one of their patients had died from an overdose, they wrote fewer opioid prescriptions for up to a year later.
The University of Southern California (USC) study built upon earlier findings that letters like these could reduce opioid prescribing over a few months.
For the new study, they sent letters to 809 clinicians — predominantly medical doctors — who had prescribed opioids to 166 people who then suffered fatal overdoses in San Diego County.
The letter was intended to be informative and respectful in tone, according to the study authors. It provided information about safer prescribing.
“Clinicians don't necessarily know a patient they prescribed opioids to has suffered a fatal overdose,” said lead study author Jason Doctor, head of health policy and management at the USC Sol Price School of Public Policy. “We knew closing this information loop immediately reduced opioid prescriptions. Our latest study shows that change in prescribing behavior seems to stick.”
Comparing prescribing patterns among these clinicians and those who had not received the letter, the researchers found the rate of reduction in opioid prescribing was faster and stronger in those who received letters.
Letter recipients wrote 7% fewer prescriptions than clinicians who hadn't received the notification, according to the report.
“The new study shows this change is not just a temporary blip and then clinicians went back to their previous prescribing,” Doctor said in a USC news release. “This low-cost intervention has a long-lasting impact.”
Over the years, the issue has evolved from a focus on the number of deaths from prescription opioids (such as OxyContin) to rising deaths from illicit opioid use, such as fentanyl (a powerful and dangerous synthetic opioid).
“The sad truth is, we never addressed the first problem of deaths from prescribed opioids," Doctor said. "In fact, it's all mixed together because nationally, approximately half of people who die of an illicit fentanyl drug overdose have also had an opioid prescription within the past year.”
He said the key takeaway is that letters from the medical examiner provide a unique opportunity to save lives.
Every year, the opioid epidemic claims about 100,000 American lives.
“The letter is a nudge to providers that the opioid epidemic is in their community and affecting their patients. It is easy to read the headlines and assume you are not part of the problem,” Doctor said, adding that clinicians have an opportunity to talk with their patients and consider alternatives to opioids.
“I believe we can reach about half of the people in the illicit fentanyl epidemic through a doctor who has seen them,” he added.
The study authors are teaming up with Los Angeles County to look at potential public policy interventions, including the possibility of mandating notifications from county medical examiners to clinicians.
The findings were published online Jan. 6 in JAMA Network Open.
The U.S. Centers for Disease Control and Prevention has more on understanding drug overdoses and deaths.
SOURCE: University of Southern California, news release, Jan. 6, 2023