Clinical trial NCT03856593: Encouraging Judicious Prescribing of Opioids in Los Angeles County
Official title: Comparative Effectiveness of Two Letters to Encourage Judicious Prescribing of Opioids: A County-wide Project in Los Angeles
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Substance-Related Disorders
Keywords: Opioids
Safe prescribing
Lead sponsor: University of Southern California
Sponsor class: OTHER
Collaborators: name: National Institute on Aging (NIA)
First posted: 2019-02-27
Enrollment: 541
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

Brief summary: In collaboration with the Los Angeles County Medical Examiner's Office and the State of California's controlled Substance Utilization Review and Evaluation System (CURES), the investigators propose to review opioid poisonings over 12 months and send letters to prescribers in California when at least one of the provider's prescription(s) was filled by a patient who died of an opioid poisoning in Los Angeles County. The letters will be non-judgmental and factual, explaining that a patient of the provider who was being treated with prescription narcotics died of an opioid poisoning. The letters will also encourage judicious prescribing including use of the CURES system before prescribing. The investigators will evaluate physician prescribing practices over 24 months (12 months pre- and 12 months post-letter) using data from the CURES database. The investigators' hypothesis is that letters will make the risk of opioids more cognitively available and that physicians will respond by prescribing opioids more carefully, resulting in fewer deaths due to misuse and more frequent use of the CURES system.


Eligibility criteria: The investigators will not be enrolling subjects. This is an evaluation of a public health intervention involving sending prescriber's factual and nonjudgmental letters, signed by the County Medical Examiner, that would state that a patient the provider had treated with controlled substances died of an opioid poisoning.

Inclusion Criteria:

* Prescribers in California for whom at least one of their prescription(s) was filled by a patient who died of an opioid poisoning in Los Angeles County

Exclusion Criteria:

* Prescriber is licensed outside the State of California and does not hold a California license, but the prescription was filled in California
* The prescriber does not have a CURES report on record
* The prescriber has issued only one opioid prescription in the last 12 months since the time of the deceased death (and the prescription was to the deceased)
* Prescriptions with unknown Drug Enforcement Agency (DEA) number

Primary outcomes:
measure: Average Weekly Change in Morphine Milligram Equivalents (MME) Dispensed
timeFrame: 52 weeks pre-letter to 4-52 weeks post-letter (excludes 0-3 weeks for washout)
Secondary outcomes:
measure: Average Weekly Change in Valium Milligram Equivalents (VME) Dispensed.
timeFrame: 52 weeks pre-letter and 4-52 weeks post-letter (excludes 0-3 weeks for washout)
Other outcomes:
Locations:
city: Los Angeles
country: United States
facility: Los Angeles County Medical Examiner's Office
state: California
Study officials:
affiliation: University of Southern California
name: Jason Doctor, PhD
role: PRINCIPAL_INVESTIGATOR
References: