Opioid illustration The modestsize of the reduction among those who were notified of a deathsuggests “that clinicians exercised greater caution with opioidsrather than abandoning use,” according to the study. (Image:Shutterstock)

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Physicians and other medical providers modestly reduced thevolume of opioids they prescribed after being told one oftheir patients had died of an overdose, according to research publishedThursday.

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“You can hear a lot of statistics about the crisis,” said Jason Doctor, lead author of thestudy, published Thursday in the journal Science. “But it alwaysfeels like it is happening elsewhere if you are not aware of anydeaths in your own practice.”

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Related: Business group urges employers to get more involvedon opioid use

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The research included more than 800 clinicians — doctors, nursepractitioners, physician assistants and dentists — comparing thosewho received a letter from the medical examiner about a patient's death andthose who didn't. The ones who knew about the overdose death cutthe overall volume of opioids they prescribed by almost 10 percentover three months, while those who didn't know prescribed roughlythe same amount as before.

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The study shows that awareness and education can changeprescribing behavior, said Doctor, lead author and associateprofessor at University of Southern California's Price School ofPublic Policy. The modest size of the reduction among those whowere notified of a death suggests “that clinicians exercisedgreater caution with opioids rather than abandoning use,” accordingto the study.

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Scott Howell, an addiction specialist and family practice doctorin Los Angeles, had not seen the study but said even a moderatechange in prescribing habits — as well as feedback from a coronerto a doctor — can be a good thing.

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Howell, a former medical director of an addiction and recoverycenter in Florida, recalled having conversations with doctors whosepatients had died. “It is very distressing for a physician,” hesaid, adding that it can make them rethink their practices. “Thatawareness is good.”

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The providers in the study who were informed about patients'deaths were also 7 percent less likely to start new patients onopioids.

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Over 19,000 people died from prescription opioids in 2016,roughly double the number 14 years earlier, according to theNational Institute on Drug Abuse. Most of that increase occurredfrom 2002 to 2011, and the numbers have been relatively stablesince then, according to the NIDA.

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Prescriptions of opioids are declining, and health officialsare seeking ways to accelerate the trend.

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The study did not measure whether the letters from the medicalexaminer or the changes in prescribing patterns had any effect onpatient deaths.

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Across the country, physicians have been accused of overprescribing opioids andhave even faced charges related to patient overdose deaths. In aneffort to better track prescribing patterns, states have startedprescription drug monitoring databases.

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Beginning this fall, California physicians must consult thestate's database, known as CURES, before prescribing certaindrugs to patients for the first time — and then must check everyfour months if those drugs are still part of the patient'streatment.

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The CDC recommends that providers avoid opioids if possible, butif they are necessary, they should start with the lowest effectivedose.

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The USC study looked at 170 patients in San Diego who died ofoverdoses from July 2015 to June 2016 and had receivedprescriptions that were tracked in the state's prescription drugmonitoring program.

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Their prescribing clinicians were randomly assigned to twogroups — those who got notice of a death and those who didn't. Theletters came from the county's chief deputy medical examiner, Dr.Jonathan Lucas. They included the name and age of the patient whohad died, explained some of the CDC's guidelines for safeprescribing and provided information on using the drug monitoringdatabase.

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The letter did not blame providers for the deaths but showedthat authorities were paying attention, according to the study.

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“We were providing them with important information and alsogiving them a way to make things better by changing prescribing,”Doctor said. “Anyone who got the letter could continue to prescribeas much as they wanted, but we found that they didn't. They becamemore judicious prescribers.”

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Lucas, who is now the chief medical examiner-coroner in LosAngeles County, said the study was an opportunity for the coroner'soffice to have a “direct impact on changing behaviors that couldreduce deaths.”

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“We moved the needle in the right direction,” he said, addingthat he is discussing the possibility of a similar effort in L.A.County. “Sending a letter is the right thing to do. Doctors knowingtheir patients passed away is important.”

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