This letter writing campaign to reduce opioid prescriptions actually works

There’s a person behind the prescription.
There’s a person behind the prescription.
Image: AP Photo/Robert F. Bukaty
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Sale of prescription opioids in the US quadrupled in the 15 years between 1999 and 2014, peaking with the 255 million opioid prescriptions US doctors wrote in 2012 alone. The nationwide prescription rate has fallen every year since, yet the damage is done.

An estimated 115 people in the US die each day from opioid overdoses, both from prescription drugs and the illicit ones many people turn to after becoming addicted to legal substances. And too many doctors still write way too many opioid prescriptions.About 25% of US counties filled at least as many opioid prescriptions as there were residents in 2016, according to the US Centers for Disease Control.

Reducing prescriptions is just one step toward reducing opioid deaths. To that end, a group of doctors devised an experiment, with results recently published in the journal Science. Over 12 months in 2015 and 2016, researchers looked at a group of 861 doctors who had prescribed opioids to patients who later died from an overdose. Of those, 388 received a letter from the medical examiner’s office in southern California’s San Diego County to tell them a patient of theirs had died—something many of the doctors would never have otherwise known.

“This is a courtesy communication to inform you that your patient [name, date of birth inserted here] died on [date inserted here],” the letters began. “Prescription drug overdose was either the primary cause of death or contributed to the death.”

The letters offered statistics on the county’s annual opioid deaths (250 to 270), and five tips for better prescribing practices, such as tapering the dosage and not prescribing combinations of opioids and tranquilizing drugs (a particularly lethal cocktail).

The researchers then tracked doctors’ prescribing habits. Doctors who received the letters prescribed between 6.2% and 13.2% fewer opioids in the three months afterward; those who did not get a letter didn’t change their habits at all.

The letters did not suggest that the doctor’s actions directly caused the patient’s death—most of the deceased patients had received prescriptions from multiple doctors. They simply served as a reminder that the doctors’ encounters with patients is only one piece of their overall health picture, lead author Jason Doctor told NPR.

“Right now, doctors are getting biased information,” he said. “They are only seeing patients that are coming back alive to their clinic, not those who die and never return.”