Encouraging Judicious Prescribing of Opioids in Los Angeles County

Not Applicable

Completed

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.

Recruitment & Eligibility

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

Arm && Interventions

Group	Intervention	Description
Standard letter	Standard letter	Prescribers randomized to this arm will be sent the standard letter.
Comparator letter	Comparator letter	Prescribers randomized to this arm will be sent the comparator letter.

Primary Outcome Measures

Name	Time	Method
Average Weekly Change in Morphine Milligram Equivalents (MME) Dispensed	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 Outcome Measures

Name	Time	Method
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)	Difference in average weekly VME 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).