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 1 year.
Program & Study Design:
The study randomized 57 surgical specialties (general, orthopedic, and obstetric/gynecologic) in 19 northern California hospitals to treatment vs. control. Over 1 year, treatment group surgeons received emails from hospital leadership on how their opioid prescribing compared to accepted guidelines or peer surgeons.
Based on careful review, this was a high-quality RCT (e.g., good baseline balance, negligible attrition, preregistered outcomes and analyses).
Findings:
Over 1 year 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.