In a new experiment, the doctors received a letter from the coroner's office informing them of their patient's fatal overdose. The answer: they began to prescribe less opioids.
Other doctors, whose patients also suffered an overdose, did not receive letters. His opiate prescription did not change.
More than 400 "Dear Doctor" letters, sent last year in San Diego County, were part of a study that, according to the researchers, put a human face on many doctors in the US opioid crisis. UU
"It's a powerful thing to learn," said University of Southern California public policy researcher Jason Doctor, lead author of the article published Thursday in the journal Science.
More than 400 letters from "Dear Doctor", sent last year in San Diego County, were part of a study that, according to the researchers, put human face to the crisis of opiates in the United States for many doctors
The researchers used a state database to find 861 doctors, dentists, and others who had prescribed opiates and other risk medications for 170 people who died of an overdose of prescription drugs. Most states have similar databases to track the prescription of dangerous drugs, where doctors can check patients' previous prescriptions.
The majority of deaths involved opioid analgesics, many taken in combination with anti-anxiety medications. On average, each person who died had filled dangerous drug prescriptions of five to six prescribers in the year before his death.
Half of the prescribers received letters that began: "This is a courtesy communication to inform you that your patient (name, date of birth) died on (date). The overdose of prescription drugs was the main cause of death or contributed to death. "
The letters offered a guide to a safer prescription. The tone was supportive: "Learning the death of your patient can be difficult, we hope you take this as an opportunity to prevent future deaths.
Then, the researchers observed what happened for three months.
The recipients of the letters reduced their average daily prescription of opiates – measured as standard, milligram equivalents of morphine – by almost 10 percent compared to those who prescribed that they did not receive letters. The prescription of opiates in the group without letter did not change.
The recipients place fewer new patients with opioids than those who did not receive letters. They wrote fewer prescriptions for opiates in high doses.
The strategy is original, useful and could be duplicated elsewhere, said pain medicine expert Dr. David Clark of Stanford University, who was not involved in the study. I was surprised that the effect of the letter was not greater.
"It could have been easy for doctors to feel that someone else prescribed who put the patient in trouble," Clark said, adding that changing the care of a single patient takes time, which requires "very difficult conversations."
Opioid prescription has been declining in the US UU For several years in response to pressure from health systems, insurers and regulators.
However, deaths continue to rise. About 48,000 Americans died from an opiate overdose last year, according to preliminary figures released last month, up 12 percent from a year earlier.
Now, illegal fentanyl, another opioid, is the leading cause of death, overcoming pain pills and heroin. The lead author, Doctor, said that reducing the number of prescribed opiates will, over time, close a gateway to illicit drugs by reducing the group of dependents.
The study did not analyze whether the deaths were due to inadequate prescription or if changes in prescription resulted in patients improving or worsening.
That's a flaw in careful study, said addiction researcher Dr. Stefan Kertesz of the University of Alabama at Birmingham, who has raised red flags on policies that cause doctors to withdraw opioid patients too quickly and without a plan. to treat addiction.
Patients may fall into despair or contemplate suicide if opioids are inadvertently reduced without support, he said.
"What really happens to patients should be our concern, rather than simply making a number decrease," Kertesz said.
The co-author of the study, Dr. Roneet Lev, chief of emergency medicine at Scripps Mercy Hospital in San Diego, discovered his own name in the data.
Lev prescribed 15 opioid pain pills to a patient with RS who broke the eye socket, not knowing that the patient received 300 painkillers from another doctor a day earlier. Lev did not receive a letter from "Dear Doctor" because the death of the patient did not fit into the study timeline, from July 2015 to June 2016.
Even so, she felt the impact and believes that she could have done better. Said Lev: "It was an opportunity to look at all the records of that patient and say:" Wow, I'm really worried about you. "