Lead author Jason Doctor, PhD, director of Health Informatics at the University of Southern California (USC) Schaeffer Center for Health Policy & Economics and Associate Professor at the Price School of Public Policy, along with coauthors, published findings of a decedent cluster randomized trial that, instead of evaluating single individuals, analyzed clusters of prescribers who were randomly allocated to intervention groups. The decedent cluster evaluated was a distinct set of prescribers who issued scheduled drug prescriptions to persons who suffered a fatal drug overdose of a prescribed scheduled opiate. The study was funded by the California Health Care Foundation and the National Institute on Aging at the National Institutes of Health.

The researchers identified 170 patients who were prescribed an opiate and subsequently experienced a fatal opiate overdose, along with over 800 prescribers who had been associated with prescribing at least one opiate prescription for one of the decedents. The prescribers were divided randomly into two separate clusters, with one of the groups receiving a letter notifying the clinician of the death and personal demographics about the deceased, signed by the medical examiner. In addition to the notice of death, the mailing also included information on safe opiate prescribing. The other group received no information.  

In the 3 months after receiving the letter, opiate prescribing decreased by nearly 10% compared with the control group, which did not receive a letter. Also, prescribers in the decedent cluster who received the letter were 7% less likely to start a new patient on opioids and less likely to prescribe higher doses.

In a recent USC press release, Dr. Doctor highlights the importance of his work. “Clinicians may never know a patient they prescribed opioids to suffered a fatal overdose,” he explains. “What we wanted to evaluate is whether closing that information gap will make them more judicious prescribers.”

Hospital pharmacists should find this information to be important for several reasons. Increasing the use of effective strategies to modify prescribing behavior to improve safe use of opiates will decrease opioid overprescribing while still allowing clinicians to take individual pain-management needs into account. Additionally, closing the information gap will result in fewer hospitalizations due to opiate overdose. It will also reduce the need to intervene with regulations that may decrease access to opiates for patients who need pain relief while at the same time preventing opioid-prescription deaths among people with common conditions for whom prescribing risks outweigh benefits.

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