Nudging Providers to Curtail Dangerous Opioid Prescribing: A Trial to Investigate Mechanisms

Study Overview
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Brief Summary
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Despite an enormous policy response, opioid prescribing remains well above historical levels and harms from opioids continue to mount. Nearly all states have Prescription Monitoring Programs (PMPs) to facilitate safer prescribing of opioids and other drugs, but research suggests these systems only deliver benefits when health care professionals are required to use them. Even with PMP mandates in place, providers may be unaware of the dangers of co-prescribing opioids with benzodiazepines or gabapentinoids, which include increased risk of overdose and death. Working with the Minnesota state government, the investigators will mail letters to guideline-discordant opioid prescribers that either highlight an upcoming legally mandated requirement to check the PMP before prescribing an opioid, inform and educate providers about patients filling concurrent prescriptions and the dangers of such co-prescribing, or both. Study participants will be randomized to receive no intervention or one of the three treatment letters. Using administrative data, the investigators will track effects of the letters on not only prescribing but also PMP usage and queries. Findings form the multiplicity of treatment messages and outcomes will shed light on the mechanisms driving overprescribing. Results will inform future work by state and local policymakers to make opioid prescribing safer.

Official Title
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Nudging Providers to Curtail Dangerous Opioid Prescribing: A Trial to Investigate Mechanisms

Conditions
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Opioid Use

Intervention / Treatment
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* Behavioral: PMP Use Mandate Letter
* Behavioral: Prescribing Information Letter
* Behavioral: Prescribing Information + PMP Use Mandate Letter


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Wrote concurrent prescription for opioids and benzodiazepines OR opioids and gabapentinoids Exclusion Criteria: Specialization in oncology or palliative medicine
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: PMP Use Mandate<br> | Behavioral: PMP Use Mandate Letter<br>* A letter with reminders about the mandate to check the PMP when prescribing opioids.<br>|
| Experimental: Prescribing Information<br> | Behavioral: Prescribing Information Letter<br>* A letter with information about the prescriber's patients who received co-prescriptions. The letters will provide clinical background on the harms of co-prescribing and encourage prescribers to avoid co-prescribing in the future.<br>|
| Experimental: Prescribing Information + PMP Use Mandate<br> | Behavioral: Prescribing Information + PMP Use Mandate Letter<br>* A letter combining the content of the PMP Use Mandate Letter and the Prescribing Information Letter. This letter will remind prescribers about the PMP use mandate and provide information about the prescriber's patients who received co-prescriptions.<br>|
| No Intervention: Control / As-Usual<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Count of Patients with Co-Prescriptions | The number of patients with co-prescriptions from the prescriber in the 60 days after the letters are sent. | 60 days | 
| Rate of Prescribers Checking PMP | Indicator for whether the prescriber checks the PMP at least once in the 60 days after the letters are sent. | 60 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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opioids, prescribing, benzodiazepines, gabapentinoids, clinical guidelines, overprescribing, Benzodiazepine Use, Gabapentin Use