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

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, we 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 their 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, we 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.

尽管政策响应规模庞大，阿片类药物的处方水平仍然远超历史水平，阿片类药物的危害亦持续加剧。几乎所有州都设立了处方监测计划（PMPs），旨在促进阿片类药物及其他药物的更安全处方，但研究指出，仅当医疗专业人员被要求使用这些系统时，这些系统才能带来益处。即使在实施PMP强制要求的情况下，提供者可能仍不了解同时处方阿片类药物与苯二氮䓬类或加巴喷丁类药物的危险，这包括增加药物过量及死亡的风险。我们与明尼苏达州政府合作，将信件邮寄给不符合指南的阿片类药物处方者，信件旨在突出即将实施的、法律规定的、在处方阿片类药物前必须检查PMP的要求，或告知并教育提供者关于其患者同时填写处方及其联合处方的危险，或两者兼备。研究参与者将被随机分配接受无干预措施或三种治疗信件之一。利用行政数据，我们将追踪信件对处方、PMP使用及查询的影响。来自多种治疗信息和结果的研究发现将揭示推动过度处方的机制。研究结果将为州和地方政策制定者提供信息，以使阿片类药物的处方更为安全。