Doctors Write Fewer Opioid Scripts After Learning of Overdose Death

Death reports make the opioid crisis personal for doctors

Death reports make the opioid crisis personal for doctors

Doctors who were informed of their patients' deaths were 7 percent less likely to start new patients on opioids and issued fewer high-dose prescriptions over the next three months, compared with those who did not receive a letter.

Opioid prescriptions have led to many fatal opioid overdoses amid the ongoing opioid epidemic.

San Diego County will be sending out these letters regularly to doctors whose patients fatally overdose, according to Lev. Their opioid prescribing didn't change.

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.

The study was led by Jason Doctor, chair of the department of health policy and management at the University of Southern California's Price School of Public Policy.

Many people who die of opioid overdoses got addicted to the drugs after they were prescribed for common problems. That is when a patient seeks several prescriptions for the same ailment to acquire more drugs. On average, each person who died had filled prescriptions for risky drugs from five to six prescribers in the year before they died.

"This is a courtesy communication to inform you that your patient (Name, Date of Birth) died on (date)".

The letter, which was supportive in tone, also provided information from the Centers for Disease Control and Prevention on safe prescribing guidelines, nudging clinicians toward better prescribing habits.

The letters offered guidance for safer prescribing. "A lot of times, they never learn about a patient's death". "We hope that you will take this as an opportunity" to prevent future deaths. The research addresses an under-recognized factor in the mounting opioid crisis - unwarranted prescriptions that set people on an initial path towards addiction.

"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. In contrast, in the control group, who received no letters, opioid prescriptions remained unchanged.

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Recipients put fewer new patients on opioids than those who didn't get letters. He was surprised the letter's effect wasn't larger.

Opioid prescribing has been declining in the US for several years in response to pressure from health systems, insurers and regulators.

Study coauthor Lev remembers learning of the death of a patient she had prescribed pain medications to.

That's a flaw in an otherwise careful study, said addiction researcher Dr. Stefan Kertesz of University of Alabama at Birmingham, who has raised red flags about policies that cause doctors to take patients off opioids too fast and without a plan for treating addiction.

"Interventions that use behavioral insights to nudge clinicians to correct course are powerful, low-priced tools because they maintain the autonomy of the physician to ultimately decide the best course of care for their patient", said Doctor.

"What actually happens to patients should be our concern, rather than just making a number go down", Kertesz said.

Lev prescribed 15 opioid pain pills to an ER patient with a broken eye socket, without knowing the patient got 300 painkillers from another doctor a day earlier.

The outcome measure of this study is prescription amounts, but Dineen says she's curious to see if mortality rates fall after doctors get these letters.

Still, she felt the impact and believes she could have done better.

"I asked other physicians if they would want to know if a patient had died", says Lev. The AP is exclusively responsible for all content.

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