Medicare letters to curb overprescribing of controlled substances had no detectable effect on providers.

Overprescribing of opioids is a serious and worsening problem. In the United States, deaths from opioid overdoses have more than quadrupled over the past decade. Providing peer comparisons has been shown to reduce other instances of medical care overuse, such as inappropriate antibiotic prescriptions. In this study, health care providers who very frequently prescribed Schedule II controlled substances (the highest risk category for which a prescription is still legal) were randomized to receive a letter showing their prescription practices compared to their peers. There was no evidence that the letters had any impact on prescribing behaviors. The authors describe ongoing efforts to redesign the letters with the hope to enhance their influence on physicians. A past WebM&M commentary discussed best practices for opioid prescribing.