Could a simple letter prompt doctors to prescribe opioids more safely?
Yes, claims new research that found reminding doctors to check a prescription database before doling out opioids increased their engagement with the program, having the potential to create more informed prescribing.
The study enrolled clinicians in Minnesota who prescribed opioids with benzodiazepines or gabapentinoids, which when taken together can increase overdose risk.
The researchers hypothesized that with greater use of state prescription monitoring programs (PMPs), doctors could avoid risky prescribing. While nearly all states now have PMPs tracking prescriptions, many clinicians still do not use them.
“PMPs could help clinicians prescribe opioids and other drugs more safely, but these databases will only move the needle if clinicians actually check them,” said study author Adam Sacarny. He is an assistant professor of health policy and management in the Columbia University Mailman School of Public Health, in New York City.
“Our research shows that simple letters can achieve that goal,” Sacarny said in a university news release.
The study included 12,000 clinicians who were randomly assigned to a control group or to receive one of three types of letters in spring 2021: mandate letters focusing on a new state requirement to check the PMP before prescribing opioids; information letters about their patients prescribed opioids with benzodiazepines or gabapentinoids; or combined letters that included both messages. The researchers partnered with the Minnesota Board of Pharmacy, which administers the PMP, and the Minnesota Management and Budget Agency.
Letters mentioning the mandate to check the PMP successfully increased engagement with the program, the study found, with PMP search rates rising 9%. The effect persisted at least eight months. Effects were similar for the combined letters.
The letters also encouraged clinicians to make PMP accounts, which was a prerequisite for searching.
“The enduring impacts suggest that the letters encouraged engagement among clinicians who would not have otherwise created PMP accounts or searched the PMP. This finding is noteworthy because account creation is an important barrier to PMP use,” said study author Mireille Jacobson, an associate professor of gerontology at the University of Southern California.
Other state PMPs or health care organizations could easily send similar letters to promote safer prescribing, the researchers noted. The letters did not contain protected health information, so could instead be sent via email at lower cost.
“While the letters did not make a detectable difference in prescribing, we still think these results are encouraging,” Sacarny said. “Letters focusing on the mandate successfully promoted PMP engagement through searching and account-holding, which meant clinicians had better access to key patient data as they decided on treatment.”
The study was supported by the Abdul Latif Jameel Poverty Action Lab and the National Institute for Health Care Management. Additional researchers were from the University of Tokyo and the RAND Corp.
The findings were published in the January issue of the journal Health Affairs.
The U.S. Department of Health and Human Services has more on overdose prevention strategies.
SOURCE: Columbia University Mailman School of Public Health, news release, Jan. 9, 2023