When patients die from overdoses, ‘a simple plan’ could change opioid prescribing

Key takeaways:

• Opioid and benzodiazepine prescriptions dropped by 12.85% and 8.32% after the intervention, respectively.
• The approach is both “affordable and scalable,” according to an expert.

Physicians who were notified that a patient of theirs had died of an overdose and received a plan with guidance on what to do in the future were less likely to prescribe opioids, a study showed.

“Providing physicians a simple plan that will guide them at a patient visit appears to help temper their use of these drugs,” Jason Doctor, PhD, co-director of the Behavioral Sciences Program at the University of Southern California Schaeffer Center for Health Policy and Economics, said in a press release. “This represents a promising approach to reducing fatal drug overdoses, one that is both affordable and scalable.”

In a randomized controlled trial, published in Nature Communications, 541 clinicians were sent letters — 284 of whom were given letters notifying them that a patient had died of an overdose, and 257 of whom received the same letters but with additional guidance.

The guidance consisted of planning prompts, which “are mental rules that describe events meant to bring about concrete actions in specific situations: If (or when) situation S occurs, then engage in behavior B,” the researchers explained.

“For example, physicians who receive a notification of a patient’s fatal overdose would be prompted to carry out a concrete plan of action that would be triggered by a specific set of circumstances (eg, when their patients present with pain),” they wrote.

The researchers found that, in the intervention group, weekly morphine milligram equivalents dropped from 157.7 to 77.05, corresponding to a 12.85% (95% CI, 6.83%-18.49%) decrease in opioid prescriptions. Similarly, average weekly diazepam milligram equivalents decreased from 51.47 to 30.16, corresponding to an 8.32% (95% CI, 2.34%-13.93%) reduction in benzodiazepine prescriptions.

“The if/when-then plan may have helped prescribers with complex or difficult patients to implement skills that promote safe prescription practices,” Doctor and colleagues suggested. “Alternatively, the prescribers with multiple deaths may have lacked skills and benefited from a letter that carefully outlined steps to improve prescription safety.”

The researchers noted their study was limited because of its sample size and its potential lack of generalizability.

Previous research by Doctor and colleagues showed that notifying a physician of a patient’s death from an overdose decreased the likelihood of opioid prescriptions for up to 1 year.

“This latest study is part of an evolution toward better understanding how to enact behavior change among physicians whose patients have suffered negative consequences from care by the medical community,” Doctor said.

References:

• Doctor J, et al. Nat Commun. 2024;doi:10.1038/s41467-023-44573-5.
• Doctor JN, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2022.49877.
• Want safer prescribing? Provide doctors with a plan for helping patients in pain. https://healthpolicy.usc.edu/article/opioid-guidance-prompt/. Published Jan. 12, 2023. Accessed Jan. 12, 2023.