Letters, guidance about overdoses may cut opioid prescribing

Alerting clinicians when patients die from a drug overdose may decrease high-dose opioid prescriptions and potentially prevent future casualties, according to a clinical trial recently published in Nature Communications.  

Clinicians who received personalized letters informing them that a patient died of an overdose along with additional planning guidance significantly reduced their prescriptions of opioids and benzodiazepines, according to the study.

“Notifications may have a lasting impact on patient safety and potentially could reduce the risk of future overdose,” wrote the authors, led by Jason Doctor, PhD, professor and co-director of the behavioral sciences program at the University of Southern California’s Schaeffer Center for Health Policy and Economics (Nat Commun, January 12, 2024, Vol. 15:263.).  

Despite widespread efforts in the U.S. to curb opioid addiction and related fatalities, excessive opioid prescribing continues. Some evidence has shown that notifying doctors about the overdose death of a patient may be effective. This trial aimed to go one step further by exploring whether sending letters along with if/when planning prompts, or guidelines that trigger certain actions based on specific situations, would be more effective in reducing the prescription rate of controlled substances.

To evaluate the impact of these letters with prompts, researchers carried out a trial with 541 clinicians in Los Angeles County. Of these clinicians, 284 received a letter and 257 received a letter with prompts, according to the trial.

Clinicians who received letters along with planning guidance decreased morphine and diazepam prescriptions by about 13% and 8%, respectively, the authors wrote.  

However, the study had limitations, including a lack of generalizability. Although Los Angeles County is one of the largest counties in the U.S., the findings may not apply universally to other populations or geographic areas, they wrote.

“With the incorporation of planning prompts into these letters, physicians may be more likely to take concrete steps to modify their prescription practices and to reduce the risk of future overdose,” Doctor et al wrote.