An interesting study with a potential technique to reduce opioid prescribing is published in Nature Communications by Doctor, J.N., Kelley, M.A., Goldstein, N.J. et al. titled A randomized trial looking at planning prompts to reduce opioid prescribing (vol.15, no. 263, 2024). The article suggests informing doctors about patients who died from overdoses, combined with specific guidance on safer prescribing practices, may be an effective way to reduce risky prescriptions of opioids and benzodiazepines.
Despite efforts in the U.S. to reduce opioid addiction and related fatalities, it is believed too many opioids are still prescribed. Some evidence has shown that notifying doctors about an overdose death of a patient may be effective. Researchers from the University of Southern California investigated this approach by sending personalized letters to clinicians in Los Angeles County. Some received letters simply notifying them about a patient’s overdose death, while others received these letters alongside “if/when planning prompts” – specific recommendations on how to modify their prescribing behaviors to minimize overdose risk in similar situations.
The trial was conducted with 541 clinicians in Los Angeles County where 284 received a letter and 257 received a letter with prompts. Doctors who received the letters with prompts significantly reduced their prescriptions of morphine and diazepam by about 13% and 8%, respectively, compared to those who received no letter or a letter alone. This suggests that just informing doctors about the consequences of their prescribing practices is not enough. It is necessary to provide concrete guidance on alternative approaches.
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The authors state:
“In conclusion, our study provides evidence that If/when-then plans as additions to fatal overdose notification letters moderate physician prescription practices.”
The study was conducted in just one county, raising questions about how applicable the findings might be to other areas. Additionally, the long-term impacts on prescribing habits and patient outcomes were not assessed. Despite such limitations, the study offers a potential tool for curbing the opioid crisis. Further research exploring broader implementation strategies could be invaluable in saving lives.