A randomized trial looking at planning prompts to reduce opioid prescribing

Prior work has demonstrated that personalized letters are effective at reducing opioid and benzodiazepine prescribing, but it is unclear whether If/when-then planning prompts would enhance this effect. We conducted a decedent-clustered trial which randomized 541 clinicians in Los Angeles County to receive a standard (n = 284), or comparator (n = 257) version of a letter with If/when-then prompts. We found a significant 12.85% (6.83%, 18.49%) and 8.32% (2.34%, 13.93%) decrease in the primary outcomes morphine (MME) and diazepam milligram equivalents (DME), respectively. This study confirms the benefit of planning prompts, and repeat letter exposure among clinicians with poor patient outcomes. Limitations include lack of generalizability and small sample size. Clinicaltrials.gov registration: NCT03856593. A personalized letter from the Medical Examiner-Coroner in Los Angeles County has proven effective at reducing opioid and benzodiazepine prescribing. Here the authors show that the introduction of if/when-then planning prompts in to the letter further reduced opioid prescribing by 12.85% and benzodiazepine prescribing by 8.32%; they were most effective for clinicians with multiple patient deaths due to accidental opioid-related overdose.