An Overdose Report may Help Reduce Opioid Overprescriptions

A JAMA Network Open clinical study found that the county medical examiner’s notice letter decrease opioid prescribing for 12 months.

According to research from a recent clinical study that was published in JAMA Network Open, an alert letter from the county’s medical examiner caused a persistent drop in opioid prescriptions over the course of the next year.

The letter informed medical professionals that a patient they had previously prescribed opioids to had recently passed away from an overdose. The communication also included safe opioid prescription practises.

This kind of letter, according to researchers, offers a low-cost intervention that can aid in changing physician behaviour.

According to Dr. Michael Lawrence Barnett, an associate professor of health policy and management at the Harvard T. H. Chan School of Public Health in Massachusetts, “This study is a fascinating follow-up to a significant experiment by the same authors published in Science in 2018 that made a major sensation.

“They sent letters to prescribers who had a patient die from an opioid overdose and, in the original study, noticed a decline in opioid prescribing three months after prescribers got the letter,” he said in an interview with Medical News Today. This study demonstrates that the effects persisted up to a year after the initial letter, even though there was less of a difference between the treatment and control groups.

“The research demonstrates that a single letter can have consequences that last a full year. Physicians probably internalised the warning and changed their practises permanently. Every county in the US has a medical examiner, so the intervention is scaleable, said Jason Doctor, PhD, a research author and professor at the Price School of Public Affairs at the University of Southern California.

Opioid overprescription

Since the late 1990s, the US has been battling the opioid crisis.

The problem has been characterised by an increase in overdose deaths, which were first mostly brought on by prescription and illicit opioids.

The original purpose of the development of opioid analgesics was to reduce pain in cancer patients.

But, in the middle and late 1990s, doctors began using prescription opioids more frequently to address pain that wasn’t caused by cancer.

Furthermore, using high dosages of opioids for lengthy periods of time was made possible by the advent of extended-release and long-acting opioid formulations in the 1990s.

An increased risk of addiction, overdose, and fatality is linked to the continuous use of opioids, especially in high dosages.

The use of heroin, an illegal opioid substance, is a risk for those who get dependent on prescription opioids.

The opioid epidemic has also been significantly fueled by the overprescription of opioids, which involves prescribing excessive dosages of opioids for common diseases when the hazards exceed the benefits.

The limited personal experiences of opiate misuse or overdose among their patients, according to researchers, may cause healthcare providers to underestimate the potential risks of prescribing large dosages of opioids. This is because patients who have not been misusing or abusing opioids are more common to be encountered by practitioners. The over prescription of opioids may also be caused by a lack of oversight by the authorities.

How a simple letter may help

In a recent study, the researchers looked at whether practitioners’ prescribing habits may be altered by receiving a letter from the county medical examiner telling them of a patient’s fatal overdose who had received an opioid painkiller from them in the preceding 12 months.

The letter was used by the researchers because they believed that memories of significant, personal encounters tend to have a bigger impact on judgement.

They claimed that receiving a letter describing a patient’s deadly overdose would remind practitioners of the harmful consequences of opioids and affect their decision to prescribe them. The practitioners would also be informed by such a letter that the authorities are keeping an eye on their prescribing habits.

The letter provided facts about the patient and informed the professionals about the number and kind of prescription drug-related overdose deaths during the preceding year. The letter also included details on how to safely prescribe opioids and how to use the state’s prescription drug monitoring programme to find out which prescription drugs the patient was taking, including opioids.

Previous research by the study’s authors had demonstrated that getting a letter from the medical examiner led to a decrease in the total amount of prescribed opioids during the three months that followed.

In the current trial, the researchers looked at whether reading such a letter could cause clinicians to consistently prescribe fewer opioids up to a year later.

Changing opioid prescription behaviors

Between July 2015 and June 2016, 826 medical professionals who had prescribed opioids to patients in the 12 months prior to their eventual death overdose were included in the study.

Randomization determined whether the clinicians would get a letter or no notice. The researchers then compared the opioid prescription trends from 12 months prior to and during the intervention.

The total amount of opioids prescribed each week between one and three months and four and twelve months after the intervention was calculated by the researchers for each group of doctors.

The prescription opioid dose was estimated in terms of morphine milligramme equivalents (MMEs), which is the amount of the prescribed opioids converted into the amount of morphine that would have the same effect. The measurements give clinicians and researchers a consistent way to gauge how potent opioids are, enabling them to make comparisons between various opioid kinds and dosages.

According to the survey, prescription opioids were the main cause of around 56% of overdose deaths. The majority of the deaths that occurred after that were brought on by mixing prescription opioids with either alcohol or illegal substances.

The clinicians in the letter-receiving group demonstrated a 7% larger drop in the total number of weekly MMEs dispensed from 4 to 12 months after the letters were written than the clinicians in the control group. Also, compared to their counterparts in the control group, the clinicians in the letter recipient group began 2% fewer new patients on opioids.

Between 1 to 3 months and 4 to 12 months after receiving the letter, the receivers exhibited no variation in the overall number of MMEs dispensed, the number of new patients started on opioid therapy, or the quantity of high-dose prescriptions.

Written by Muhammad Qasim