Opioid prescribing decreases after learning of a patient’s fatal overdose

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Science  10 Aug 2018:
Vol. 361, Issue 6402, pp. 588-590
DOI: 10.1126/science.aat4595

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Feedback reduces opioid prescriptions

Most people addicted to opioids began taking them because they were legally prescribed. Little attention has been paid to changing physicians' prescribing behavior. Using a randomized controlled trial format, Doctor et al. monitored the effect of notifying physicians who had a patient die of opioid overdose within 12 months of a prescription. The physicians received an injunction to prescribe safely from their county's medical examiner. This intervention led to reductions in high-intensity prescribing, reductions in the likelihood that an opioid-naïve patient received a prescription, and a reduction in overall cumulative opioid intake.

Science, this issue p. 588


Most opioid prescription deaths occur among people with common conditions for which prescribing risks outweigh benefits. General psychological insights offer an explanation: People may judge risk to be low without available personal experiences, may be less careful than expected when not observed, and may falter without an injunction from authority. To test these hypotheses, we conducted a randomized trial of 861 clinicians prescribing to 170 persons who subsequently suffered fatal overdoses. Clinicians in the intervention group received notification of their patients’ deaths and a safe prescribing injunction from their county’s medical examiner, whereas physicians in the control group did not. Milligram morphine equivalents in prescriptions filled by patients of letter recipients versus controls decreased by 9.7% (95% confidence interval: 6.2 to 13.2%; P < 0.001) over 3 months after intervention. We also observed both fewer opioid initiates and fewer high-dose opioid prescriptions by letter recipients.

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