There’s a new way to fight the opioid epidemic – letters sent to doctors who’ve prescribed these dangerous drugs to patients who may by at risk of dying from an overdose.  The letters doctors received from the county medical examiner included pointed and shocking information.  A patient you once prescribed an opioid medication has died in the last year from a drug overdose.  Doctors who received these letters reduced their prescribing of opioids by just under 10 percent compared with those who didn’t.Another letter being sent warns primary care physicians that the federal government had flagged them for prescribing too many antipsychotic medications, and those who received the letters have decreased their opioid prescriptions by 15 percent over two years.Both letters were sent as part of an experiment to see how effective low-cost incentives could be in shifting the mindset toward prescribing addicting painkillers, and they suggest that, when the message is designed to grab one’s attention, the solution can be inexpensive and still have an impact.

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“If you rewind the clock a month before these papers came out, there was no example of a really simple, easily scalable intervention that could move prescribing by a significant magnitude,” said Adam Sacarny, an assistant professor of health policy at Columbia and a co-author of the antipsychotic prescribing paper. “We now have two papers that show that simple letters really can change prescribing.”Both letters were blunt and came from government sources.  They also suggested that doctors are being watched by the government and would be held accountable for overprescribing.  They detail the possibility of harm to patients.Researchers have been excited about the possibility of instituting a cost-effective approach that actually works.  These letters are also easier to test than many alternatives.  Both were examined using randomized controlled experiments.It’s unclear if the letters helped doctors avoid prescribing drugs to patients who could be harmed or just helped to reduce prescribing in general.  And, the problem is still a dire one.  “The world needs bigger changes than what you saw in the studies,” said Peter Ubel, a professor of business, public policy and medicine at Duke. “But what a nice start.”“If you want to stop something from happening, you have to build up rocks by the river, along the edge, to dam it up,” said Jason Doctor, a co-author on the opioids prescribing paper.  He said if these nudges were added to new medical guidelines, they could be part of a more large-scale solution to the problem.“This finding could be very useful in the effort to reduce inappropriate prescribing of opioids without severely restricting availability of legally prescribed opioids for patients who should be getting them,” said National Institute on Aging (NIA) Director Richard J. Hodes, M.D. “It shows that physicians respond to information about adverse outcomes. “Behavioral ‘nudges’ like these letters could be a tool to help curb the opioid epidemic.”“The NIA has supported a number of studies on changing clinicians’ behaviors through this type of intervention,” said John Haaga, Ph.D., director of NIA’s Division of Behavioral and Social Research. “This study illustrates one small and relatively inexpensive method of reducing the number of opioid prescriptions written, thus reducing the number of drugs available for misuse.”

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Notification of patient overdose deaths reduces clinician opioid prescriptionsHere’s a Cheap Way to Fight Drug Misuse: Send Doctors a Sharp Letter