Friday, August 10, 2018

Opioid Prescribing Found to Drop After Physicians Notified of Patient Death From Overdose

Physicians who were notified by letter from a medical examiner that a former patient had died of an opioid overdose reduced their subsequent opioid prescribing by around 10%, according to a study published yesterday in Science.

“Clinicians may prescribe with greater care when they perceive they are being watched,” wrote lead author Jason Doctor. Ph.D., of the University of Southern California and colleagues. “A message communicating a patient’s overdose death from the medical examiner may have particular weight."

Doctor and colleagues identified 170 individuals who had died of an opioid overdose in San Diego County between July 1, 2015, and June 30, 2016, and had received a legitimate opioid prescription. The individuals were randomly assigned to two groups. For one group of decedents, the 404 physicians who had prescribed opioids to them received a letter from the medical examiner. The letter was intended to be supportive and included safe opioid-prescribing strategies developed by the Centers for Disease Control and Prevention as well as information on how to access the California state prescription drug monitoring program. The control group consisted of the 457 physicians who prescribed to the other half of the decedents.

Four months after the letters were mailed, opioid prescribing among the 404 physicians in the intervention group dropped from 72.5 MMEs (milligram morphine equivalents) per physician a day to 65.7 MMEs per physician a day. Rates held steady in the control group (71.6 and 71.7 MMEs before and after the notification, respectively). The authors also found that physicians in the intervention group were about 7% less likely than controls to start new patients on opioids.

“Judicious prescribing represents only one of the components necessary to correct the missteps caused by overly enthusiastic use of opioids to relieve pain,” Doctor and colleagues wrote. “Access to medication-assisted therapies, counseling, and naloxone for resuscitation after overdose and efforts to address social determinants responsible for increased opioid use all play equally important roles in ending the crisis.”

To read more about opioid prescribing practices, see the Psychiatric News article “Opioid Prescribing Falls But but Still Remains High” and the Psychiatric Services article “Prescriptions Filled Following an Opioid-Related Hospitalization.



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