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Jan. 6 (UPI) -- One partial solution to the U.S. opioid crisis is to tell doctors when their patients have died from an overdose, a study published Friday suggests. A letter from the county medical examiner was found to reduce notified doctors' opioid prescribing more than those doctors left uninformed, with lasting effect, according to a research letter in JAMA Network Open.
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The researchers from the University of Southern California acknowledged there is no simple solution to America's deadly overdose epidemic, which they said killes 100,000 people a year and erases gains in life expectancy.
But they said this single, low-cost intervention can make a difference.
In 2018, the USC research team found that physicians reduced the number of opioid prescriptions they wrote over the next three months after being notified in a letter from their county's medical examiner of a patient's fatal overdose from a Schedule II to IV drug.
The primary cause of death was attributable to an opioid prescription in these cases, rather than the combined effects of an illicit drug or alcohol, the research paper says.
The researchers found a 9.7% decrease in prescriptions filled for morphine milligram equivalents, up to 3 months after the letter's receipt. And they saw a drop in new starts and high doses of opioids in the panels of informed clinicians.
Their new study shows the patient overdose death notifications' effects in reducing doctors' opioid prescribing lasted up to a year after the letter's receipt.
"Clinicians don't necessarily know a patient they prescribed opioids to has suffered a fatal overdose," Professor Jason Doctor, the study's lead author and chair of the Department of Health Policy and Management at the USC Sol Price School of Public Policy, said in a news release.
"We knew closing this information loop immediately reduced opioid prescriptions. Our latest study shows that change in prescribing behavior seems to stick," said Doctor, co-director of the Behavioral Sciences Program at the USC Schaeffer Center for Health Policy & Economics.
In the study, notification letters were sent to 809 clinicians, mostly medical doctors, who had prescribed opioids to 166 people who had died from overdoses in San Diego County.
The researchers then compared prescribing patterns among these clinicians to those who had not received the letter.
Total weekly MMEs dispensed decreased 7.1% more in the letter intervention group than in the control group at four to 12 months after the letter's receipt.
And new patients taking opioids decreased by 2.02 percentage points more at four to 12 months post-notification among intervention vs. control prescribers.
"Awareness of being observed, an injunction from authority, and the availability of harm may explain" the medical examiner letter's lasting effect, the research paper says.
The study "did not address the alarming acceleration of fatal overdoses by illicit fentanyl," the paper concludes. "Considering the changing pandemic-related causes of death, future research should assess patient-reported outcomes and determine whether such letters could encourage medication-assisted therapy initiation.
Medication-assisted therapy is the use of medications, in combination with counseling and behavioral therapies, to provide a "whole-patient" approach to treating substance use disorders, according to the Substance Abuse and Mental Health Services Administration, a part of the Department of Health & Human Services.
