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.
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.