Opioid Overdoses Affect Prescription Writing

Disconnect from personal experience of patient loss due to fatal overdose related to a prescription from clinicians makes the problem of the nation’s opioid crisis seem remote. While the epidemic continues to exert impact opioid prescription writing levels have not responded with adequate risk benefit analysis by prescribers tasked with caring for patients with pain.

Behavioral insights and psychology leveraged in this study provided a more personal experience with risk associated to opioids, with findings showing when clinicians learn of patient death due to fatal overdose opioid prescriptions were decreased by 10% in the next 3 months.

861 clinicians who prescribed opioids to 170 patients that had subsequently died from fatal overdose were included in this randomized trial, half of which were selected at random to receive letter from the county medical examiner notifying them they had prescribed opioids to a patient in the past 12 months had a fatal overdose, with supportive tone and literature, and provided information from the CDC on safer prescribing habits to nudge them in that direction.

Opioid prescriptions were observed to decreased by 9.7% among intervention prescribers within 3 months, to add to that those receiving letters were found to be 7% less likely to start new patients on opioids and less likely to prescribe higher doses.

Results are optimistically positive given that numerous traditional state regulations that involve mandated limits on opioids haven’t been shown to have much impact. Simplicity of this low cost intervention of sorts is also positive as it allows the clinicians to have the choice to decide how to proceed when provided an important piece of clinical information, which is easily scalable to use nationwide as existing state and national resources already track the information necessary around overdose deaths. Low cost, simple intervention using behavioral insights to nudge clinicians to a new course are powerful as they maintain autonomy of the physician to decide best course of care for their patients. Some doctors may not fully grasp certain conditions when observing patients, providing information about harm and outcomes that may go unseen provides physicians a clearer picture.