Effect of Prescriber Notifications of Patient’s Fatal Overdose on Opioid Prescribing at 4 to 12 Months is the title of a short paper on the JAMA Open Network. It describes what happens when a physician or physician extender receives a letter from the county medical examiner informing him that his patients has died from an overdose of the medicine he prescribed. Unsurprisingly the author of the fatal script will prescribe less morphine milligram equivalents (MME) over the following year.

That a letter from the county medical examiner induces paresis of the providers pen that lasts for a year seems predictable. Whether the reduction in providing needed pain relief is in the best interests of the surviving patients is not addressed in this brief report. A decrease in adequate treatment of pain inevitably follows the dissemination of the deadly effects of a prescription pain reliever. The study discussed here does not mention the circumstances of the fatal overdoses. Was death the result of taking an opioid as directed or was it secondary to increasing the dose above that prescribed?

That physicians need to execute good judgement in the prescription of any drug with a potentially life threatening effect – which of course is true of any prescription drug – is axiomatic. The net benefit of sending letters from a government official to health providers such as described in the study in question is difficult to assess and the authors, as mentioned above, made no attempt to evaluate whether an official notice of death proved beneficial for the surviving patients. Patients overdose from a variety of non-opioid drugs. Perhaps the county medical officer should send letters to every provider who has a patient who overdosed from any prescription drug.

The practice of medicine requires knowledge, good judgement, and appropriate follow-up. The intrusion of the government into the delivery of medicine is inevitable. Its benefit is less certain. The paper also contains an accurate description of the statistical methods used that only an accountant conjured by Dickens could love. Here it is in all its statistical jargon so soporific that it could be used in place on an opioid as reading it more than once could induce narcosis. Perhaps a letter from the county medical officer will follow.

We evaluated the change in total weekly MMEs dispensed using a mixed-effects regression with interactions between conditions, at 1 to 3 months and 4 to 12 months after the intervention. The model was left-censored to account for weeks with no prescribing. We used logistic regression to analyze new starts on opioids and high-dose prescriptions of at least 50 and 90 MME. We report model-adjusted 5% trimmed means and bootstrapped 95% CIs. Using a t test, we also evaluated whether there was any degradation in treatment effect by coefficients at the 2 time points. Two-sided P < .05 was considered statistically significant. 

As the paper is not behind a paywall and is open to all, it’s appended below.

Effect of Prescriber Notifications of Patients Fatal Overdose on Opioid Prescribing at 4 to 12 Months