This simple “low-cost intervention has a long-lasting impact” and could be the key to addressing America’s deadly overdose epidemic. With this new approach, the experts say, we may be able to make a real difference in the lives of those affected by this crisis.

There is no easy way to stop the overdose epidemic in the U.S., which kills 100,000 people each year and is reversing gains in life expectancy. However, a group of USC researchers has shown that a low-cost intervention may make a difference: a letter informing providers that their patient has died from an overdose.

According to a 2018 study, informing healthcare professionals about their patient’s fatal overdose through a letter from the county medical examiner led to a decrease in the number of opioid prescriptions written in the following three months. A new study, published in JAMA Network Open, reveals that these notifications had a lasting impact for up to a year after the initial notification was sent.

According to lead author Jason Doctor, “clinicians don’t necessarily know a patient they prescribed opioids to has suffered a fatal overdose.” 

As explained by the lead author, they knew that “closing this information loop immediately reduced opioid prescriptions,” and their new study shows “that change in prescribing behavior seems to stick.”

A cheap and effective way to improve public health

Doctor and his colleagues wrote to 809 clinicians—mostly medical doctors—who had dispensed opioids to 166 San Diego County residents who had overdosed fatally. The letter’s tone was supposed to be one of respect and information while describing safer prescription practices. The prescription habits of these practitioners were compared to those of clinicians who had not received the letter by the researchers.

Even though opioid prescriptions went down over time for everyone, the people who got the letter went down at a faster and stronger rate, the study authors found. After a year, individuals who had gotten the letter had written 7% fewer prescriptions than those who hadn’t.

“The new study shows this change is not just a temporary blip and then clinicians went back to their previous prescribing,” adds Doctor. “This low-cost intervention has a long-lasting impact.”

Doctor admitted that the increasing mortality toll from illegal opioid usage, especially during the COVID-19 crisis, has overshadowed the death toll from legally prescribed medications.

“The sad truth is, we never addressed the first problem of deaths from prescribed opioids,” says the author, adding, “in fact, it’s all mixed together because nationally, approximately half of people who die of an illicit fentanyl drug overdose have also had an opioid prescription within the past year.”

Medical examiners can prevent opioid overdoses

Doctor said the most important thing to remember is that the medical examiner’s letters provide a rare chance to communicate with doctors after overdose fatalities, increasing the likelihood that lives will be saved from the use of both legal and illicit opioids.

According to Doctor, the informational letter serves as a reminder to healthcare providers that the opioid epidemic is present in their community and affecting their patients. It encourages them to have conversations with their patients and consider alternative treatment options to opioids. 

Doctor believes that by utilizing this approach, they have the potential to reach a significant portion of those impacted by the “illicit fentanyl epidemic” through the help of healthcare professionals who have treated them.

Doctor and the other authors of the study are currently working with Los Angeles County to figure out what can be learned from the research and to look at possible changes to public policy, such as making it a requirement for county medical examiners to send these notifications to clinicians.

Source: 10.1001/jamanetworkopen.2022.49877

Image Credit: “The Faces of Fentanyl” wall, which displays photos of Americans who died from a fentanyl overdose, at the Drug Enforcement Administration (DEA) headquarters in Arlington, Virginia, on July 13, 2022. – AGNES BUN/AFP via Getty Images


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