Dear Doc­tor: Keep an eye on the opi­oids Big jump in moms hooked on opi­oids

Physi­cians nudged by an over­dose let­ter pre­scribe fewer dan­ger­ous painkillers.

The Hazleton Standard-Speaker - - HEALTH & SCIENCE - BY CARLA K. JOHN­SON

In a novel ex­per­i­ment, doc­tors got a let­ter from the med­i­cal ex­am­iner’s of­fice telling them of their pa­tient’s fa­tal over­dose. The re­sponse: They started pre­scrib­ing fewer opi­oids.

Other doc­tors, whose pa­tients also over­dosed, didn’t get let­ters. Their opi­oid pre­scrib­ing didn’t change.

More than 400 “Dear Doc­tor” let­ters, sent last year in San Diego County, were part of a study that, re­searchers say, put a hu­man face on the U.S. opi­oid cri­sis for many doc­tors.

“It’s a pow­er­ful thing to learn,” said Univer­sity of South­ern Cal­i­for­nia pub­lic pol­icy re­searcher Ja­son Doc­tor, lead author of the pa­per pub­lished Thurs­day in the jour­nal Science.

Re­searchers used a state data­base to find 861 doc­tors, den­tists and oth­ers who had pre­scribed opi­oids and other risky med­i­ca­tions to 170 peo­ple who died of an over­dose in­volv­ing pre­scrip­tion medicines. Most states have sim­i­lar data­bases to track pre­scrib­ing of dan­ger­ous drugs, where doc­tors can check pa­tients’ pre­vi­ous pre­scrip­tions.

Most of the deaths in­volved opi­oid painkillers, many taken in com­bi­na­tion with anti-anx­i­ety drugs. On av­er­age, each per­son who died had filled pre­scrip­tions for dan­ger­ous drugs from five to six pre­scribers in the year be­fore they died.

Half the pre­scribers re­ceived let­ters that be­gan: “This is a cour­tesy com­mu­ni­ca­tion to in­form you that your pa­tient (name, date of birth) died on (date). Pre­scrip­tion drug over­dose was ei­ther the pri­mary cause of death or con­tributed to the death.”

The let­ters of­fered guid­ance for safer pre­scrib­ing. The tone was sup­port­ive: “Learn­ing of your pa­tient’s death can be dif­fi­cult. We hope that you will take this as an op­por­tu­nity” to pre­vent fu­ture deaths.

Then the re­searchers watched what hap­pened over three months.

Let­ter re­cip­i­ents re­duced their av­er­age daily opi­oid pre­scrib­ing — mea­sured in a stan­dard way, mor­phine mil­ligram equiv­a­lents — by nearly 10 per­cent com­pared to pre­scribers who didn’t get let­ters. Opi­oid pre­scrib­ing in the no-let­ter group didn’t change.

Re­cip­i­ents put fewer new pa­tients on opi­oids than those who didn’t get let­ters. They wrote fewer pre­scrip­tions for high-dose opi­oids.

The strat­egy is orig­i­nal, help­ful and could be du­pli­cated else­where, said pain medicine U.S. heAlth of­fi­ciAls sAy they found A drA­mAtic rise in the num­ber of women who Are hooked on opi­oids And de­liv­er­ing bA­bies in hos­pi­tAls.

Opi­oid use dur­ing preg­nAncy cAn cAuse deAth of the mother or bAby, preterm birth And in­fAnt with­drAwAl symp­toms like seizures, ex­ces­sive cry­ing And breAth­ing prob­lems. The Cen­ters for Dis­eAse Con­trol And Preven­tion stud­ied de­liv­ery hos­pitAl­izA­tions in 28 stAtes — the Agency’s first study of the prob­lem Across mul­ti­ple stAtes. It re­leAsed its find­ings Thurs­dAy.

In 1999, 1.5 of ev­ery 1,000 women com­ing to A hos­pi­tAl to de­liver de­pended on or Abused opi­oids.

ThAt rose to 6.5 in 2014, the lAt­est yeAr for which dAtA is AvAil­Able. ThAt trAns­lAtes to neArly 25,000 de­liv­er­ies Across All 50 stAtes thAt yeAr. RAtes were high­est in Ver­mont And West Vir­giniA.

ex­pert Dr. David Clark of Stan­ford Univer­sity, who wasn’t in­volved in the study. He was sur­prised the let­ter’s ef­fect wasn’t larger.

“It may have been easy for physi­cians to feel it was some­body else pre­scrib­ing who got the pa­tient in trou­ble,” Clark said, adding that chang­ing even one pa­tient’s care takes time, re­quir­ing “very dif­fi­cult con­ver­sa­tions.”

Opi­oid pre­scrib­ing has been de­clin­ing in the U.S. for sev­eral years in re­sponse to pres­sure from health sys­tems, in­sur­ers and reg­u­la­tors.

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