Sunday, August 19, 2018

How to cut opiod prescriptions

First, make sure that clinicians know about patient overdoses! A randomized controlled trial involved 861 clinicians in San Diego:

About half of them served as the control. The other half received this letter: “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 or contributed to the death.” ... The researchers hypothesized that the letter would reduce opioid prescriptions. To test that hypothesis, they compared the number of opioid prescriptions a few months before and a few months after the letter was sent. In the control group, prescriptions stayed pretty steady (actually they increased modestly). In the group of clinicians that received the letter, by contrast, prescriptions decreased significantly. And those clinicians were less likely to start new patients on opioids at all.


  1. A great example of the rational actor paradigm! People will make operate rationally if they are informed and have the right incentives -

  2. The fact is, as a deputy coroner, you have to contact the physician to determine whether or not the patient had an extensive medical hx, then determine the amount of medication taken vs the amount left in the bottle, also as to whether or not there are other drugs in the system which will be done by toxicology which takes weeks for a return answer. All the while, we are determining who will be signing a death certificate which depends on medical hx and other evidence which we will not go into here. point is, the doctor would be notified of the death.