In California, A Coroner’s Letter Changes How Doctors Prescribe Opioids

A doctor prescribes medication.

It seems like a small thing, just letters from a county coroner to 388 California medical doctors, telling them that one of their patients died from a prescription drug overdose. But despite its apparent simplicity, it was powerful enough to change the number of pills these doctors prescribed to their next patients.

What did this letter say? Its fairly bland, non-accusative terms avoided suggesting that the doctor had in any way directly contributed to the patients’ deaths. It was constructed as a “courtesy communication” about this patient’s death and informed the doctor how many prescription-related deaths occur in San Diego County each year. This was followed by prescribing advice that could help the doctor reduce the chance of overdoses among their patients. It then recommended an online program for further education.

In each case, the doctors receiving these letters had prescribed one or more drugs known to carry a risk of abuse and overdose for this deceased patient. These prescriptions had been issued in the year prior to the patient’s death.

These 388 doctors received letters informing them of the death of a total of 82 patients. These numbers reveal the fact that most of these 82 patients were seeing multiple doctors to get the number of pills they felt they needed.

What Happened after These Letters Were Received?

A doctor reads a letter.

It seems that these letters brought home to these doctors the concept that they could have been involved to some degree or another with the deaths of these patients. No longer were these people far-off “statistics”—they were patients these doctors had been responsible for.

After they received this letter, the prescribing rates of these 388 doctors were monitored. Over the next few months, they reduced their prescribing of opioid medications nearly 10% when compared to doctors who did not receive such a letter. Fewer patients were started on these medications and there were fewer prescriptions for the highest doses of these opioids.

The group used for comparison consisted of 447 OTHER doctors who had prescribed the same kinds of drugs to 85 patients who also died from overdoses. But they received no “courtesy communication.”

A 10% reduction is not a huge change, true. But the opioid epidemic will never be overcome with one tactic or one approach. It’s going to take dozens or maybe even hundreds of small changes like these to roll back our prescribing rates to their levels before our problems with opioids began to take so many lives… before Americans and American doctors and nurses became convinced that pain after an injury or surgery should be blotted out completely with opioids… before patients were asked to rate their pain during each visit and fill out a satisfaction survey after the visit.

The needed changes are going to take place in doctor’s offices, emergency rooms and hospitals, nursing homes, private homes, pharmacies, schools, businesses and legislative chambers. Reducing our number of overdose deaths is something that nearly every American can contribute to in ways both big and small.

To learn how you might be able to help, please take a look at the list of articles below.


Karen Hadley

For more than a decade, Karen has been researching and writing about drug trafficking, drug abuse, addiction and recovery. She has also studied and written about policy issues related to drug treatment.