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Researchers from Columbia University and USC reported promising new findings from a clinical trial of letters to promote safer and better-informed opioid prescribing. The study, which aimed to encourage clinicians to check on patients in a state database before prescribing them opioids, reported significant and durable gains on this endpoint. The research was published online in the journal Health Affairs.

The study enrolled clinicians who prescribed opioids with benzodiazepines or gabapentinoids. Taking these medications together can increase the risk of overdose. The researchers hypothesized that greater use of state prescription monitoring programs (PMPs), which track all prescriptions of these medications, could help clinicians avoid these risky prescriptions. Nearly all states now run PMPs, but many clinicians still do not use them, explained the study’s senior author, Mireille Jacobson, associate professor at the USC Leonard Davis School of Gerontology and co-director of the Aging and Cognition Program at the USC Schaeffer Center for Health Policy and Economics.

“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 Adam Sacarny of Columbia University Mailman School of Public Health, the study’s first author. “Our research shows that simple letters can achieve that goal.”

The researchers partnered with the Minnesota state PMP to run the trial. They enrolled 12,000 clinicians who prescribed opioids with benzodiazepines or opioids with gabapentinoids. The clinicians were then randomly assigned to a control group or to receive one of three types of letters: mandate letters focusing a new state requirement to check the PMP before prescribing opioids, information letters about their risky prescribing, or combined letters that included both messages. The letters were sent in early 2021.

Sacarny, Jacobson, and co-authors analyzed the effects of the letters using de-identified data from the PMP. The data included all opioid, benzodiazepine, and gabapentinoid prescriptions dispensed throughout Minnesota, as well as all PMP account records and searches.

The researchers found that letters mentioning the mandate to check the PMP successfully increased engagement with the program. PMP search rates rose by 9%, and the effect persisted at least 8 months. The letters also encouraged clinicians to make PMP accounts, a prerequisite for searching. Effects were similar for the combined letters, which mentioned the mandate and also included prescribing information.

“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,” Jacobson noted.

The researchers note that other state PMPs or healthcare organizations could easily send similar letters as a part of a cost-effective evidence-based strategy to promote safer prescribing. Because the mandate letters contain no protected health information, they could also be sent over e-mail, further lowering the intervention cost.

The researchers detected no effects of the information letters, which did not focus on the new mandate to check the PMP. None of the letters led to detectable changes in prescribing.

“While the letters did not move the needle on prescribing, we still think these results are encouraging,” noted Sacarny. “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 research was conducted in partnership with the Minnesota Board of Pharmacy and Minnesota Management and Budget Agency, which promotes the use of high-quality evidence to improve state decision-making. Along with Sacarny and Jacobson, the study’s co-authors are Tatyana Avilova of the University of Tokyo, David Powell of the RAND Corporation, and Ian Williamson and Weston Merrick of the Minnesota Management and Budget Agency. The study was supported by the Abdul Latif Jameel Poverty Action Lab and the National Institute for Health Care Management.

Release courtesy Columbia University Mailman School of Public Health

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