Opioids: Nudge To Reduce Consumption

For over two decades now, opioid use in North America has been increasing at an alarming rate, affecting people's well-being and ultimately even claiming lives, and very few public-health strategies have been able to halt the damage.

Now a new study led by medication safety specialists in Canada and Australia suggests that a simple, government-led, direct-to-consumer, educational intervention can help long-term users of prescribed opioids cut their dosages.

In their study, published in JAMA Open Network, Université de Montréal's Cara Tannenbaum and Monash University's Justin Turner evaluated a public-health effort to mail an educational brochure to all regular opioid users living in a Canadian province: Manitoba.

Over six months in 2018, 66 per cent of the 2,136 people who received the brochure got their doctors to reduce the dosages they prescribed. That's close to 3 per cent more than was observed in the 2,070 who weren't mailed the brochure but cut their dosages anyway.

The difference was especially acute among men, people over 65 and people living in urban areas. Among those, the drop in dosages among brochure recipients versus non-recipients was close to 4 per cent in men and seniors, and almost 6 per cent in city residents.

"It's encouraging to see that such a seemingly simple intervention, launched at the height of the opioid crisis, could help people reduce their use," said Tannenbaum, the study's senior author, a medical professor and geriatrics specialist at UdeM.

"Our study highlights the potential for governments to educate and empower individuals to make informed decisions about their opioid use," added Turner, an Australian who was on a postdoctoral fellowship at the UdeM-affiliated Centre de recherche de l'Institut universitaire de gériatrie de Montréal when the study was being carried out.

"When they get evidence-based information directly, these people lower their consumption considerably," said Turner, now a senior lecturer at Monash's Centre for Medicine Use and Safety, in Melbourne. "Further analysis showed a drop in mortality from all causes among brochure recipients - an important finding that merits more investigation."

Regular users of prescribed opioids are mostly medical outpatients suffering chronic pain. They may have long-standing rheumatoid arthritis, for instance, or a slipped disc in their back, or neurologic pain after an amputation. These patients are to be distinguished from users of street opioids such as illegal fentanyl whose overdoses continue to make headlines.

The Manitoba brochure initiative grew out of a conference held in Montreal in 2018 by the Canadian Appropriate Medication and Deprescribing Network, co-founded by Tannenbaum. At the time, she was the network's co-director, and Turner its scentific director.

Tannenbaum also held UdeM's Michel-Saucier Pharmacy Chair in Health and Aging, which partially funded the study, along with the Canadian Institutes of Health Research and the government of Manitoba.

"Our results underscore the importance of patient education in promoting the appropriate use of medications," said Tannenbaum. "By engaging patients in their treatment decisions and providing them with the necessary information, we can contribute to safer and more effective opioid management strategies."