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

Summary

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.

Conditions

• Opioid Use

Interventions

BEHAVIORAL

PMP Use Mandate Letter

A letter with reminders about the mandate to check the PMP when prescribing opioids.

BEHAVIORAL

Prescribing Information Letter

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.

BEHAVIORAL

Prescribing Information + PMP Use Mandate Letter

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.

Sponsors & Collaborators

• University of Southern California

  collaborator OTHER

• Minnesota Management and Budget Agency

  collaborator UNKNOWN

• Minnesota Board of Pharmacy

  collaborator OTHER

• Columbia University

  lead OTHER

Principal Investigators

• Adam Sacarny, PhD · Columbia University

• Mireille Jacobson, PhD · University of Southern California

• David Powell, PhD · RAND

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2021-04-15

Primary Completion

2021-07-12

Completion

2021-07-12

Countries

• United States

Study Locations