Coroner sent letters to doctors whose patients died of opioid overdoses. Doctors’ habits quickly changed

Addressed directly to the doctor, the letter arrived in a plain business envelope with a return address of the San Diego County medical examiner’s office. Its contents were intended, ever so carefully, to focus the physician on a national epidemic of opioid abuse — and his or her possible role in it.

“This is a courtesy communication to inform you that your patient [name, date of birth inserted here] died on [date inserted here]. Prescription drug overdose was either the primary cause of death or contributed to the death,” the letter read.

In the blandest of clinical language, the “courtesy communication” went on to inform the doctor of how many medication-related deaths the San Diego County medical examiner sees each year (between 250 and 270). It offered five prescribing tips (or “evidence-based interventions”) proven to help lower overdose death rates. And it steered the doctor to an online program designed to help medical professionals who are “dedicated to avoiding prescribing controlled substances when they are likely to do more harm than good.”

The letters — signed by San Diego County’s chief deputy medical examiner, Dr. Jonathan Lucas, who has since become Los Angeles County’s chief medical examiner — were part of an experiment to gauge how to reduce the prescribing of drugs implicated in fatal overdoses.

At a time when legally prescribed opioids and other medications are claiming 174 lives a day in the United States, the research aimed to test a new way to get physicians to rethink their prescribing habits.

Medical societies, state boards and the federal government have sought for several years to educate doctors and dentists about the risks of prescribing opioids, with limited results. The new research is among the first to take a different tack: Get physicians, who are inclined to view the opioid crisis as stemming from other doctors’ poor management, to understand how their own decisions may contribute in small ways to a national epidemic. And then give them tools to guide a change in behavior.

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