Comparative Effectiveness of Two Letters to Encourage Judicious Prescribing of Opioids: A County-wide Project in Los Angeles
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 541
- Locations
- 1
- Primary Endpoint
- Average Weekly Change in Morphine Milligram Equivalents (MME) Dispensed
Study Overview
Brief Summary
In collaboration with the Los Angeles County 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 12 months and 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 Los Angeles 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 letters 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, resulting in fewer deaths due to misuse and more frequent use of the CURES system.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Other
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •The investigators will not be enrolling subjects. This is an evaluation of a public health intervention involving sending prescriber's factual and nonjudgmental letters, signed by the County Medical Examiner, that would state that a patient the provider had treated with controlled substances died of an opioid poisoning.
- •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 Los Angeles County
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)
- •Prescriptions with unknown Drug Enforcement Agency (DEA) number
Arms & Interventions
Standard letter
Prescribers randomized to this arm will be sent the standard letter.
Intervention: Standard letter (Behavioral)
Comparator letter
Prescribers randomized to this arm will be sent the comparator letter.
Intervention: Comparator letter (Behavioral)
Outcomes
Primary Outcomes
Average Weekly Change in Morphine Milligram Equivalents (MME) Dispensed
Time Frame: 52 weeks pre-letter to 4-52 weeks post-letter (excludes 0-3 weeks for washout)
Difference in average weekly MME dispensed 52 weeks pre-letter to 4-52 (excludes 0-3 weeks for washout) post-letter. Measure of interest is the difference in the above measure between prescribers randomized to the standard letter and the comparator letter, referred to as the difference-in-difference (interaction coefficient).
Secondary Outcomes
- Average Weekly Change in Valium Milligram Equivalents (VME) Dispensed.(52 weeks pre-letter and 4-52 weeks post-letter (excludes 0-3 weeks for washout))
Investigators
Jason Doctor
Professor
University of Southern California