According to the Centers for Disease Control and Prevention (CDC), opioid overdose is responsible for 91 deaths in this country every day. That statistic, as tragic as it is, can remain just that for most people — a statistic without names or faces. But what if you’re one of the physicians who has prescribed an opioid that contributed to a patient’s death? Would you change your prescribing practices after that?
A recent study explored that very question.
San Diego doctors receive sobering news
Last year over 400 physicians practicing in San Diego County received letters from the medical examiner informing them that one of their patients had succumbed to a prescription-related overdose. The letter started off this way:
“This is a courtesy communication to inform you that your patient (name, date of birth) died on (date). Prescription drug overdose was either the primary cause of death or contributed to the death.”
Researchers then tracked the prescribing habits of those doctors over a period of three months following the receipt of the letter. and compared that data with the prescribing patterns of doctors who also had patients die due to drug overdose but who had not received a letter. The group in receipt of a letter showed a decrease in the number of opioid prescriptions they dispensed.
“It’s a powerful thing to learn,” University of Southern California public policy researcher Jason Doctor, the lead author of the study, told the Associated Press.
Letter calls for care when prescribing opioids
The letter did more than inform doctors of their patients’ deaths, however. It also encouraged a fresh assessment of prescribing decisions. “Learning of your patient’s death can be difficult. We hope that you will take this as an opportunity [to prevent future deaths].”
As in many states, California has a database that tracks the prescriptions of controlled substances. This allows practitioners to learn of medications their patients had taken in the past, or may be taking at the present time. Researchers identified more than 800 physicians and dentists who had prescribed potentially dangerous drugs (predominantly opioids) to 170 individuals who later passed away because of a prescription medication overdose.
Regarding the patients, records show that each of them had, on average, filled prescriptions for potentially dangerous medications they had obtained from five to six different prescribers within the twelve months preceding their deaths. Many of the opioid painkillers involved in the fatal overdoses were taken in conjunction with medications to treat anxiety.
Opioid prescriptions down by 10% in recipient group
Practitioners who had received a letter prescribed 10% fewer opioids than doctors who had not (the latter group showed no change in prescribing habits). The doctors with letters in-hand originated fewer prescriptions for opioids in the high-dose range, and they also prescribed fewer opioids for new patients.
Although not involved in the study, pain medicine expert Dr. David Clark of Stanford University commented on it to the Associated Press. He expressed surprise that the observable impact on prescribing habits wasn’t more dramatic, theorizing that “[i]t may have been easy for physicians to feel it was somebody else prescribing who got the patient in trouble.” Clark noted that adjusting patient care is time-consuming, and, in these scenarios demands “very difficult conversations.”
Clark also opined that this method of informing doctors of the overdose-related deaths of their patients is worth replicating in other areas of the country.
The paper describing the study was published in Science earlier this month.
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