Opioid prescribing decreases after learning of a patient's fatal overdose
Opioid prescribing decreases after learning of a patient's fatal overdose
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DOI：
10.1126/science.aat4595
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发表时间：
2018-08-10
期刊：
影响因子：
56.9
通讯作者：
Menchine, Michael
中科院分区：
文献类型：
--
作者：
Doctor, Jason N.;Nguyen, Andy;Menchine, Michael
大多数阿片类药物处方死亡发生在患有常见疾病的人群中，这些患者开处方的风险大于益处。一般的心理学见解提供了一个解释：在没有可用的个人经验的情况下，人们可能会判断风险较低，在没有观察到的情况下可能会不如预期那么谨慎，并且在没有权威禁令的情况下可能会犹豫不决。为了检验这些假设，我们对 861 名临床医生进行了一项随机试验，为 170 名随后因服药过量而致命的患者开了药。干预组的临床医生收到了患者死亡的通知以及所在县法医发出的安全处方禁令，而对照组的医生则没有。干预后 3 个月内，收信人患者处方中的毫克吗啡当量与对照组相比下降了 9.7%（95% 置信区间：6.2 至 13.2%；P < 0.001）。我们还观察到，信件接收者使用阿片类药物的次数减少了，高剂量阿片类药物的处方也减少了。
Most opioid prescription deaths occur among people with common conditions for which prescribing risks outweigh benefits. General psychological insights offer an explanation: People may judge risk to be low without available personal experiences, may be less careful than expected when not observed, and may falter without an injunction from authority. To test these hypotheses, we conducted a randomized trial of 861 clinicians prescribing to 170 persons who subsequently suffered fatal overdoses. Clinicians in the intervention group received notification of their patients' deaths and a safe prescribing injunction from their county's medical examiner, whereas physicians in the control group did not. Milligram morphine equivalents in prescriptions filled by patients of letter recipients versus controls decreased by 9.7% (95% confidence interval: 6.2 to 13.2%; P < 0.001) over 3 months after intervention. We also observed both fewer opioid initiates and fewer high-dose opioid prescriptions by letter recipients.