Telling doctors about their patients' opioid deaths curbed prescriptions
A study published in Science found that telling doctors in San Diego County of a patient's overdose death led to that physician prescribing fewer opioids.
The county's medical examiner sent a letter to physicians whose patients died within a year of an opioid prescription. The notification included information about safe prescribing.
The letter led to lower high-intensity prescribing, fewer opioid prescriptions and overall lower opioid intake, according to the report. The study found "modest prescribing reductions," suggesting clinicians used more caution rather than completely stopping opioid prescriptions.
More than 350,000 people died as the result of an opioid overdose between 1999 and 2016. More than 1.9 million Americans suffer from opioid addiction, according to the study.
The randomized trial of 861 clinicians prescribing to 170 patients who subsequently suffered fatal overdoses included those receiving the letter as well as a control group that didn't receive the correspondence. Milligram morphine equivalents in prescriptions filled by patients of letter recipients decreased by nearly 10% over three months versus controls. There was also a 3% decrease for 50 MME daily doses and a 4.5% decrease for 90 MME daily doses.
The researchers said traditional state regulatory approaches haven't lowered opioid use or deaths, but the method used in this study could work because the letter is "impactful, recent and easy to retrieve from memory" and physicians may decrease opioid prescriptions because they know an official, such as a medical examiner, is watching. Another benefit of this approach is that it's scalable and can be done by every state.
The authors suggested the letter can be part of a multi-layered response to over-prescribing. Medication-assisted therapy, counseling, naloxone for resuscitation after a patient overdose and programs that target social determinants of health can "all play equally important roles in ending the crisis," they said.
Payers, providers and policymakers are all looking for ways to reduce opioid abuse. However, a recent report from researchers at the Mayo Clinic found that prescription rates remained level for commercially insured patients between 2007 and 2016.
Opioid supply levels have decreased as states have set limits on opioid prescriptions. Avalere recently said supply levels were 11% lower in 2017 compared with 2016. Twenty-two states have laws that limit opioid prescriptions, either by length or amount of medicine prescribed.
Federal regulators are also making efforts. CMS sent 24,000 letters to Medicare physicians with higher rates of opioid prescriptions over the past two years.
A recently-released agency roadmap lays out its approach to the epidemic, including medication-assisted treatment for opioid use disorder. CMS has also approved state Medicaid demonstrations seeking to improve treatment for addiction.