Letters make dent in opioid prescriptions

Published Aug 28, 2018 at 4:00pm

The National Institute on Drug Abuse is reporting that 115 people die every day from opioid overdoses in the U.S., a fivefold increase from the end of the 20th century. The NIDA estimates the “economic burden” of opioid abuse to the country at $78.5 billion annually.

And, according to a report in the Jacksonville (Fla.) Daily News, the Centers for Disease Control and Prevention say 40 percent of overdose deaths are linked to prescription opioids.

The CDC also has noted that Alabama physicians lead the U.S. in the number of opioid prescriptions written -- 5.8 million of them in 2015, about 1.2 prescriptions for every man, woman and child in the state.

There has been progress. The American Medical Association reported in May that opioid prescriptions nationwide declined 22 percent from 2013 to 2017. The report credited increased access to and use of state prescription drug databases; increased access to naxolone, which can reverse the effects of opioid overdoses; and an increase in the number of physicians who specialize in treating opioid overdoses.

Plus there was something in an Associated Press story earlier this month that caught our eye. As an experiment, letters bearing the address of the medical examiner’s office in San Diego County, California, were sent to more than 400 physicians, dentists and others who had prescribed opioids to patients who ultimately died of overdoses.

Those targets, a control group in a total of 861 prescribers selected from a state database, got letters telling them that their patients had died. The letters provided the date of the deaths, stated that a prescription drug overdose was the primary or contributing cause and offered guidelines for safer prescribing.

The researchers, whose findings were published in the journal Science, revisited the data three months later and found that the physicians who had received letters were writing 10 percent less opioid prescriptions; there was no change for those who didn’t get letters.

The study drew criticism, however, from some observers who pointed out that there was no consideration as to whether the prescriptions that led to the fatalities were medically justified, and no assessment of how the reduction in opioid prescriptions affected patients’ quality of life.

And while every pain doesn’t require an opioid -- that mind-set helped get us to this point -- experts are rightly concerned about the prospect of patients who truly need pain-killers either suffering unnecessarily or being cut off from their meds if not cold turkey, then with the barest weaning-off process. (That’s how desperate people end up dealing with pushers.)