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).
Findings:
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.
Comment:
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.