Behavioral Insights to Encourage Judicious Prescribing of Opioids

Not Applicable

Completed

• Conditions: Substance-Related Disorders
• Interventions: Other: Letters

• Registration Number: NCT02790476
• Lead Sponsor: University of Southern California

Brief Summary

In collaboration with the San Diego Medical Examiner's Office and the State of California's controlled Substance Utilization Review and Evaluation System (CURES), the investigators propose to review opioid poisonings over the past 12 months and will send letters to prescribers in California when at least one of the provider's prescription(s) was filled by a patient who died of an opioid poisoning in San Diego County. The letters will be non-judgmental and factual, explaining that a patient of the provider who was being treated with prescription narcotics died of an opioid poisoning. The letter will also encourage judicious prescribing including use of the CURES system before prescribing. The investigators will evaluate physician prescribing practices over 24 months 12 months pre- and 12 months post-letter using data from the CURES database. The investigators' hypothesis is that letters will make the risk of opioids more cognitively available and that physicians will respond by prescribing opioids more carefully. This will result in fewer deaths due to misuse and more frequent use of the CURES system.

Detailed Description

Not available

Basic Information
|
Recruitment & Eligibility
|
Study & Design
|
Trial Locations

Study Timeline

• Study First Submitted: 2016-05-27
• Study First Submitted QC: 2016-06-01
• Study First Posted: 2016-06-06
• Study Start: 2017-01-27
• Primary Completion: 2017-05-27
• Study Completion: 2018-02-27
• Results First Submitted: 2022-08-29
• Status Verified: 2023-11
• Results First Submitted QC: 2023-11-09
• Last Update Submitted: 2023-11-09
• Results First Posted: 2024-04-29
• Last Update Posted: 2024-04-29

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 851

Inclusion Criteria

• Prescribers in California for whom at least one of their prescription(s) was filled by a patient who died of an opioid poisoning in San Diego County

Read More

Exclusion Criteria

• Prescriber is licensed outside the State of California and does not hold a California license, but the prescription was filled in California
• The prescriber does not have a CURES report on record
• The prescriber has issued only one opioid prescription in the last 12 months since the time of the deceased death (and the prescription was to the deceased)
• Prescribers with unknown Drug Enforcement Agency number

Read More

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Letter intervention	Letters	The intervention arm will involve letters sent to prescribers in San Diego County.

Primary Outcome Measures

Name	Time	Method
Number of Opioid Prescriptions for > 90 Morphine Milligram Equivalent (MME) and ≥ 50 MME	12 months	The hypothesis is that there will be fewer opioid prescriptions both at a dose \> 90 morphine milligram equivalent (MME) and at a dose ≥ 50 MME among prescribers receiving the letter intervention, compared to control prescribers not receiving the letter intervention.
Number of Opioid and Benzodiazepine Co-prescriptions	12 months	The hypothesis is that there will be fewer opioid and benzodiazepine co-prescriptions for prescribers receiving the letter intervention, compared to control prescribers not receiving the letter intervention.
Average Change Over Time in Dispensed Narcotics	12 months	The hypothesis is that the average change over time in dispensed narcotic represented as monthly morphine milligram equivalent (MME) dose will be larger for prescribers receiving the letter intervention, compared to the average change over time for the control prescribers not receiving the letter intervention.

Secondary Outcome Measures

Name	Time	Method
Frequency of CURES Use	12 months	The hypothesis is that there will be more frequent use of CURES among prescribers receiving the letter intervention, compared to control prescribers not receiving the letter intervention.
Number of "New Start" Prescriptions	12 months	The hypothesis is that there will be fewer prescriptions for opioid naïve patients by prescribers receiving the letter intervention, compared to control prescribers not receiving the letter intervention.

Trial Locations

Locations (1)

San Diego County Medical Examiner's Office; 🇺🇸 San Diego, California, United States