Opinion: Surgeons give patients too many opioids. A few simple steps could curb excess prescribing

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America’s opioid pandemic is arsenic bad arsenic it has ever been. Although nan crisp summation successful opioid overdose deaths complete nan past decade is mostly attributed to nan rise successful fentanyl distributed done supplier cartels, a startling number tin beryllium traced to prescriptions. In fact, nan Centers for Disease Control and Prevention estimates that 45 group died each time successful 2021 from a medicine opioid overdose — astir one-fifth of each opioid-related deaths.

Some efforts to curb opioid prescribing person shown promise, including prescription supplier monitoring programs, promotion of replacement analgesics, supplier acquisition and informing prescribing physicians erstwhile their patients dice from opioid overdoses. But location is 1 aesculapian specialty for which opioids are still a important portion of astir patients’ curen plan: surgery. Nearly each diligent discharged aft room leaves nan infirmary successful important pain, which is why surgeons prescribe much opioids than almost immoderate different specialty.

Most patients, however, do not usage each nan opioids they are prescribed aft an operation. That leaves excess pills successful circulation and helps substance nan epidemic. If we could get surgeons to prescribe only nan number of pills patients request for their ain use, this could greatly trim nan number of excess pills disposable for diversion and misuse, among patients, their families and members of their communities. This, successful turn, could trim addiction and overdoses.

Minimizing really often a room diligent ends up pinch other opioids would not lick nan crisis, but it’s portion of nan solution — and it’s achievable.

Changing prescribers’ behaviour is hard. They get group successful their ways, moored by a beardown belief that what they are doing is champion for their patients. Moreover, they strenuously defy attempts to constrain their state to determine what is best. Our investigation squad looked to behavioral subject for ways to nudge providers to prescribe successful accordance pinch champion practices, while leaving them pinch afloat autonomy to take what they deliberation would beryllium best.

Conventional strategies for curbing excessive opioid prescribing presume that surgeons are logical actors who, whenever they are informed astir diligent needs and incentivized to be to them, will enactment to maximize nan use of patients. If that were nan case, simply educating doctors astir nan dangers of overprescribing mightiness beryllium sufficient.

However, galore studies from experimental psychology and behavioral economics person shown that group are highly selective successful nan accusation they attraction connected and much socially minded than accepted models of logical self-interest would predict.

Such insights from behavioral subject supply promising avenues for curtailing excessive opioid prescribing by surgeons. For instance, 1 group of researchers recovered that setting nan default opioid quantity successful nan physics wellness grounds strategy to lucifer nan magnitude patients really usage substantially reduces nan magnitude of opioids prescribed. Apparently, engaged surgeons tended to spell pinch nan travel erstwhile prescribing — presumably because nan default number of pills became a salient reference point, was easiest to participate and suggested a norm of correct behavior.

Surgeons, for illustration different humans, are societal animals who are powerfully motivated to adhere to nan norms of bully behaviour endorsed by their peers. We capitalized connected this for our caller study, a randomized proceedings to trial 2 elemental interventions crossed 19 hospitals successful Northern California for a year.

In 1 version, nan emails informed surgeons that they had prescribed much pills than different surgeons successful their wellness strategy had been prescribing for nan aforesaid procedure. This connection highlighted “descriptive” norms of existent behavior. In a second, simpler version, whenever a surgeon prescribed opioid amounts that exceeded recommended quantities for nan process they had performed, we sent nan expert an email notification informing them. This involution highlighted “injunctive” norms of perfect behavior.

Surprisingly, some societal norm interventions had nan nonstop aforesaid effect connected prescribing. Subsequent patients were astir 25% little apt to person an opioid medicine that exceeded nan recommended amount. This resulted successful astir 42,000 less pills successful nan organization for nan 26,000 patients who were portion of nan involution group.

Imagine really galore less pills would beryllium prescribed if this were scaled up nationwide, fixed that location are much than 50 cardinal inpatient surgical procedures performed each twelvemonth successful nan U.S. Surely this would lead to millions, if not tens of millions, less opioid pills circulating successful nan U.S. each year.

Inexpensive solutions grounded successful grounds connected quality behaviour tin beryllium powerful devices successful our run against opioid addiction. Sometimes conscionable a ray touch — a tweak to nan default settings successful nan physics wellness strategy aliases an automated email to surgeons — tin person an outsize effect connected prescribing decisions pinch life-or-death consequences.

Zachary Wagner is simply a wellness economist astatine USC and Rand. Craig R. Fox is simply a professor of psychology and medicine astatine UCLA and chair of nan Behavioral Decision Making Area astatine nan UCLA Anderson School of Management.

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latimes