Doctors Modestly Cut Prescriptions After Learning of an Opioid Death

Physicians who knew of an overdose death cut volume by almost 10 percent over three months, a study finds.

Physicians and other medical providers modestly reduced the volume of opioids they prescribed after being told one of their patients had died of an overdose, according to research.

“You can hear a lot of statistics about the crisis,” said Jason Doctor, PhD, lead author of the study, published Aug. 9, 2018, in the journal Science. “But it always feels like it is happening elsewhere if you are not aware of any deaths in your own practice.”

Anyone who got the [medical examiner] letter could continue to prescribe as much as they wanted, but we found that they didn’t. They became more judicious prescribers.


Jason Doctor, PhD, lead author of the study

The research included more than 800 clinicians — doctors, nurse practitioners, physician assistants and dentists — comparing those who received a letter from the medical examiner about a patient’s death and those who didn’t. The ones who knew about the overdose death cut the overall volume of opioids they prescribed by almost 10 percent over three months, while those who didn’t know prescribed roughly the same amount as before.

The study shows that awareness and education can change prescribing behavior, said Doctor, lead author and associate professor at University of Southern California’s Price School of Public Policy in Los Angeles. The modest size of the reduction among those who were notified of a death suggests “that clinicians exercised greater caution with opioids rather than abandoning use,” according to the study.

The providers in the study who were informed about patients’ deaths were also 7 percent less likely to start new patients on opioids.

The letter did not blame providers for the deaths but showed that authorities were paying attention, according to the study.

“We were providing them with important information and also giving them a way to make things better by changing prescribing,” Doctor said. “Anyone who got the letter could continue to prescribe as much as they wanted, but we found that they didn’t. They became more judicious prescribers.”

More than 19,000 people died from prescription opioids in 2016, roughly double the number 14 years earlier, according to the National Institute on Drug Abuse. Most of that increase occurred from 2002 to 2011, and the numbers have been relatively stable since then, according to the NIDA.

Meanwhile, opioid prescriptions are declining, and health officials are seeking ways to accelerate the trend.

The study did not measure whether the letters from the medical examiner or the changes in prescribing patterns had any effect on patient deaths.

Across the country, physicians have been accused of overprescribing opioids and have even faced charges related to patient overdose deaths. To better track prescribing patterns, states have started prescription drug monitoring databases.

The Centers for Disease Control and Prevention recommends that providers avoid opioids if possible, but if they are necessary, they should start with the lowest effective dose.

This story originally was published on August 10, 2018, by Kaiser Health News.

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