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JAMA Health Forum published an RCT of email feedback to surgeons to reduce over-prescribing of opioids after surgery (thought to be a significant driver of opioid addiction). Quick take: High-quality RCT finds encouraging 5-6% point reduction in over-prescribing over 1y.
Program & Study Design:
  • The study randomized 57 surgical specialties (general, orthopedic, & obstetric/gynecologic) in 19 northern California hospitals to treatment (over 1y, surgeons received emails from hospital leadership on how their opioid prescribing compared to accepted guidelines or peer surgeons) vs control.

  • Based on careful review, this was a high-quality RCT (e.g., good baseline balance, negligible attrition, preregistered outcomes & analyses).

  • Over 1y follow-up, the study found that the feedback emails reduced the percent of discharged patients with opioid prescriptions above accepted guidelines from 37% (control) to 31-32% (treatment) - a statistically significant difference.

  • A key remaining question is whether reduced over-prescribing will lead to less downstream opioid misuse by patients.

  • Although such downstream effects seem plausible, the history of RCTs shows that plausible-seeming effects sometimes don't materialize. So I think this intervention would be a great candidate for a replication RCT with a large-enough sample to measure patient opioid misuse.

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