How to curb the opioid epidemic? Tell doctors which of their patients died.
A new approach to fighting the opioid crisis involves sending letters to doctors after their patients overdose on prescription drugs.
On January 27, 2017, a letter went out to 388 doctors stating, simply:
“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.”
It was part of simple yet innovative experiment, one designed to answer the question: Will physicians become more judicious in their opioid prescribing habits after they receive personally tailored letters alerting them that one or more of their patients had died from the medication?
The study was published Thursday in the journal Science. For the study, researchers led by Jason Doctor of USC’s Leonard D. Schaeffer Center for Health Policy and Economics selected 388 physicians who had “prescribed a schedule II, III, or IV drug to a person who died as a result of a schedule II, III, or IV accidental overdose between the period of 1 July 2015 and 30 June 2016 in San Diego County.”
The researchers then sent these doctors a carefully crafted letter, which they described as “supportive in tone” and designed to alert the doctors of the deadly potential consequences of opioid prescriptions—not to accuse them of playing a direct role in the patient’s death. Most patients had received prescriptions from multiple doctors.
In the three months after the ‘courtesy communications’ were sent, physicians who received letters reduced their prescribing of opioids by about 10 percent and started about 7 percent fewer patients on a new opioid regimen.
“It’s sort of a process,” study co-author Dr. Jonathan Lucas, who signed the letters and has since become Los Angeles County’s chief medical examiner, told the Los Angeles Times. “If we had extended the study period out to a year or so, we probably would have seen a bigger difference.”
This kind of blunt, emotional approach could become regular in the battle against the opioid epidemic. San Diego, for example, is already planning to roll out an initiative to send letters to doctors when their patients die of an overdose, and Los Angeles is considering doing the same.
“I have to imagine it’s gut-wrenching,” said Dr. Sean Michael, a University of Colorado emergency physician who’s studied opioid prescribing habits but was not involved in the study, told the Los Angeles Times. “The job that everybody is trying to do on a daily basis is the exact opposite of this outcome. The intention when people wrote these prescriptions was to try to help someone, not to accidentally kill them. But that’s the problem: The edge is so narrow and the risk is so high with these medications.”
The National Institute on Drug Abuse estimates that more than 115 people die every day in the U.S. from overdosing on opioids, including heroin, prescription pain relievers and synthetic opioids like fentanyl. It’s a trend that’s increasing at a disturbing rate, according to Robert Anderson, chief of the mortality statistics branch at the National Center for Health Statistics.
“We’ve gone well beyond [the AIDS epidemic] now,” he told the Washington Post. “It’s hard to take in.”
In 2017, about 49,000 people died from opioid-related causes. Alarmingly, that number might be conservative: A study published in June described how some states report unintentional drug overdose deaths as ‘unspecified’, and estimated that as many as 70,000 of these unspecified overdose deaths from 1999 to 2015 might be attributable to opioids.
The new version's battery has a shorter range and a price $4,000 lower than the previous starting price.
- Tesla's new version of the Model 3 costs $45,000 and can travel 260 miles on one charge.
- The Model 3 is the best-selling luxury car in the U.S.
- Tesla still has yet to introduce a fully self-driving car, even though it once offered the capability as an option to be installed at a future date.
"It's about having employees that are empowered."
Denmark may be the birthplace of the Lego tower, but its workplace hierarchy is the flattest in the world.
According to the World Economic Forum's Global Competitiveness Report 2018, the nation tops an index measuring "willingness to delegate authority" at work, beating 139 other countries.
We all know sleeping with your ex is a bad idea, or is it?
- In the first study of its kind, researchers have found sex with an ex didn't prevent people from getting over their relationship.
- Instead of feeling worse about their breakup after a hookup, the new singles who attempted sexual contact with their ex reported feeling better afterwards.
- The findings suggest that not every piece of relationship advice is to be taken at face value.
Want a happy, satisfying relationship? Psychologists say the best way is to learn to take a joke.
- New research looks at how partners' attitudes toward humor affects the overall quality of a relationship.
- Out of the three basic types of people, people who love to be laughed at made for better partners.
- Fine-tuning your sense of humor might be the secret to a healthy, happy, and committed relationship.
It's hard to imagine such a number. But these images will help you try.
The Mega Millions lottery just passed $1 billion for tonight's drawing.
What does that even look like, when represented by various currencies?
It takes just 6 numbers to win. You can only, however, purchase tickets up until 10:45 ET tonight.
Tiny and efficient, these biodegradable single cells show promise as a way to target hard-to-reach cancers.
- Scientists in Germany have found a potential improvement on the idea of bacteria delivering medicine.
- This kind of microtargeting could be useful in cancer treatments.
- The microswimmers are biodegradable and easy to produce.
Metin Sitti and colleagues at the Max Planck Institute in Germany recently demonstrated that tiny drugs could be attached to individual algae cells and that those algae cells could then be directed through body-like fluid by a magnetic field.
The results were recently published in Advanced Materials, and the paper as a whole offers up a striking portrait of precision and usefulness, perhaps loosely comparable in overall quality to recent work done by The Yale Quantum Institute. It begins by noting that medicine has been attached to bacteria cells before, but bacteria can multiply and end up causing more harm than good.
A potential solution to the problem seems to have been found in an algal cell: the intended object of delivery is given a different electrical charge than the algal cell, which helps attach the object to the cell. The movement of the algae was then tested in 2D and 3D. (The study calls this cell a 'microswimmer.') It would later be found that "3D mean swimming speed of the algal microswimmers increased more than twofold compared to their 2D mean swimming speed." The study continues —
More interestingly, 3D mean swimming speed of the algal microswimmers in the presence of a uniform magnetic field in the x-direction was approximately threefolds higher than their 2D mean swimming speed.
After the 2D and 3D speed of the algal was examined, it was then tested in something made to approximate human fluid, including what they call 'human tubal fluid' (think of the fallopian tubes), plasma, and blood. They then moved to test the compatibility of the microswimmer with cervical cancer cells, ovarian cancer cells, and healthy cells. They found that the microswimmer didn't follow the path of bacteria cells and create something toxic.
The next logical steps from the study include testing this inside a living organism in order to assess the safety of the procedure. Potential future research could include examining how effective this method of drug delivery could be in targeting "diseases in deep body locations," as in, the reproductive and gastrointestinal tracts.
Our modern-day Kafka on his new novel Lake Success and the dark comedy that in 2018 pretty much writes itself
- riding the Greyhounds of hell, from New York to El Paso
- the alternate reality of hedge fund traders
Here's why the school you went to is less relevant than ever.
- Learning agility is the ability to learn new things quickly and be aware of the trends that are emerging in your industry. It's the most important job skill hiring managers should be looking for and job seekers should be putting forward, says Kelly Palmer.
- Want to test your learning agility? Answer this practice interview question: "What did you learn last week?"
- Hiring people based on the school they went to is less relevant than ever. Why? Palmer explains: "If I asked you, "Tell me about your health," and you told me you ran a marathon 10 years ago, does that really tell me what your health is like? Not really." It's what you can offer now and how agile you are that matters.
- Kelly Palmer is the author of The Expertise Economy.
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