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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
  • Fig. 1 Consort diagram.

    ME, medical examiner.

  • Table 1 Decedent characteristics.

    OTC, over the counter; n, number of clinicians.

    CharacteristicRandomization groupStatisticP value
    Letter (n = 82)Control (n = 85)
    Age (±SD)49.75 (11.15)48.21 (14.85)t = 0.0590.954
    Male53 (65%)44 (52%)χ2(1) = 0.5910.442
    Race
    Black6 (7%)8 (9%)
    Hispanic8 (10%)4 (5%)
    Native American01 (1%)χ2(5) = 4.752*0.447*
    Asian/Pacific Islander01 (1%)
    Non-Hispanic White65 (79%)70 (82%)
    Other3 (4%)1 (1%)
    Cause of death
    Prescription41 (50%)53 (62%)
    Prescription and illicit27 (33%)15 (18%)
    Prescription and alcohol10 (12%)13 (15%)χ2(5) = 5.3000.380
    Prescription, illicit, and alcohol2 (2%)2 (2%)
    Prescription and OTC1 (<1%)1 (<1%)
    Prescription, alcohol, and OTC1 (<1%)1 (<1%)

    *For all races.

    †For all causes of death.

    • Table 2 Prescriber characteristics.

      Professional practiceRandomization groupStatisticP value
      LetterControl
      Medical doctor (MD)277315
      Doctor of osteopathy (DO)3029
      Nurse practitioner (NP)2426
      Physician assistant (PA)4448χ2(4) = 1.173*0.883*
      Dentistry (DDS/DND)1320
      Total388438

      *For all professional practices.

      • Table 3 Adjusted daily average milligram morphine equivalents (MMEs) dispensed per prescriber among persons randomized to the intervention or control groups.

        Values in parentheses are 95% CIs with 5% trimmed means.

        ParameterRandomization group
        LetterControl
        Prescribers followed388438
        Preintervention72.5
        (71.3 to 73.7)
        71.6
        (70.3 to 72.8)
        Postintervention65.7
        (63.8 to 67.5)
        71.7
        (70.0 to 73.5)
        Increment (pre- to post-)−6.8
        (−9.9 to −3.8)
        0.1
        (−2.8 to 3.2)
        Difference in increment−6.9
        (−13.1 to −1.0)
        P value0.001

      Supplementary Materials

      • Opioid prescribing decreases after learning of a patient's fatal overdose

        Jason N. Doctor, Andy Nguyen, Roneet Lev, Jonathan Lucas, Tara Knight, Henu Zhao, Michael Menchine

        Materials/Methods, Supplementary Text, Tables, Figures, and/or References

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        • Materials and Methods
        • Supplementary Text S1
        • Figs. S1 and S2
        • Tables S1 to S3
        • References

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