Solving America’s painkiller paradox

Here’s how to fix America’s painkiller problem — without leaving pain patients behind.

his year, researchers uncovered a simple method for getting doctors to reduce profligate prescriptions of drugs like OxyContin and Percocet that have contributed to America’s opioid epidemic: informing doctors that one of their patients had died.

In their study, which was published in Science in August, researchers sent a letter, through the local medical examiner, to 388 clinicians in San Diego County, California, informing them that a patient they’d prescribed a drug to had overdosed and died. The letter, which was based on actual events, came with instructions and recommendations from the Centers for Disease Control and Prevention (CDC) on proper opioid prescribing. Another 438 clinicians who had patients die were tracked but not sent letters; they were the comparison group.

The results: Clinicians who got the letters prescribed nearly 10 percent fewer opioids than those who did not receive a letter. The letter-receiving clinicians were also less likely to start patients on opioids and less likely to give patients higher doses of opioids.

For researchers, it was a promising outcome — the discovery of a nudge that could help abate an opioid epidemic that has become the deadliest drug overdose crisis in US history.

“It’s one piece of the puzzle; it’s not the end-all solution,” Jason Doctor (yes, Dr. Doctor), the lead researcher on the study, told me. “I think we’re going to need a lot of these nudges to bring prescribing down.”

The nudge stands in contrast to the more heavy-handed policy efforts that lawmakers around the country have embraced lately to limit doctors’ opioid prescribing abilities. Congress is currently considering setting caps on how long doctors can prescribe opioids for, and several states have already passed such limits. Some states have gone even further; Oregon has considered a Medicaid policy that would force chronic pain patients off opioids.

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