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Medical examiner letters telling clinicians a patient died of overdose (San Diego and Los Angeles counties)

County medical examiners in California mailed clinicians a courtesy letter saying a patient they had prescribed to had died of a prescription drug overdose, with safe-prescribing guidance. San Diego County tested it in a randomized trial (published 2018); Los Angeles County repeated it with added "if/when-then" planning prompts.

Years
2017–2020
Country
United States
Topic
Opioids
Asks people to
Stop
Strategy
TestimonialTrusted messenger
Channel
Direct mail
Audience
Clinicians
Physicians, dentists, nurse practitioners and other clinicians who had prescribed scheduled drugs to a patient in the 12 months before that patient's fatal overdose.

Evidence

ExperimentalPositive

San Diego RCT, 861 clinicians linked to 170 decedents: morphine milligram equivalents filled by letter recipients' patients fell 9.7% vs controls over 3 months, with fewer new opioid starts and fewer high-dose prescriptions (Doctor 2018). A secondary analysis looked at benzodiazepine prescribing (Kelley 2022, research letter, no abstract). Los Angeles RCT, 541 clinicians (preregistered NCT03856593): adding if/when-then planning prompts cut MME a further 12.85% and diazepam equivalents 8.32% vs the standard letter (Doctor 2024).

Sponsor (who paid)

  • San Diego County Medical Examiner State local government, sender (first trial)
  • Los Angeles County Department of Medical Examiner-Coroner State local government, sender (second trial)

Credits (who made it)

  • USC Schaeffer Center (Jason Doctor and colleagues) Research evaluation, 2016-2024 source

Related campaigns

Sources

  1. Doctor JN, Nguyen A, Lev R et al. Opioid prescribing decreases after learning of a patient's fatal overdose. Science 361(6402):588-590 evaluation · 2018 · DOI 10.1126/science.aat4595 · PMID 30093595
  2. Kelley MA, Lev R, Lucas J et al. Association of Fatal Overdose Notification Letters With Prescription of Benzodiazepines. JAMA Intern Med evaluation · 2022 · DOI 10.1001/jamainternmed.2022.3372 · PMID 35994260
  3. Doctor JN, Kelley MA, Goldstein NJ et al. A randomized trial looking at planning prompts to reduce opioid prescribing. Nat Commun 15:263 evaluation · 2024 · DOI 10.1038/s41467-023-44573-5 · PMID 38216566
  4. Opioid prescribing fell after clinicians told their patient had died of overdose (STAT, 9 Aug 2018) news · 2018
  5. Opioid Prescribing Decreases After Learning of a Patient's Fatal Overdose (USC Schaeffer, 9 Aug 2018) news · 2018

Research notes

Clinician-facing campaign. Discovered 2026-10-22 for #17 (clinician-campaigns pass). Fetched 2026-10-22: STAT (letters from the San Diego County medical examiner, signed by chief deputy ME Jonathan Lucas, sent to 380+ prescribers), USC Schaeffer release, Nature Communications page and PMC10786898 (Los Angeles County decedents late October 2018 to late May 2020; 541 clinicians). Years are approximate: San Diego mailing year not found on a fetched page (startYear 2017 is an estimate from the 2018 publication); endYear 2020 = end of the Los Angeles decedent window, letters may have gone out later. The literature doc (A4) labels Kelley 2022 'Los Angeles County'; its author list (Lev, Menchine) matches the San Diego trial, so it is probably a secondary analysis of that trial - not confirmed. One-off letter programs, not standing campaigns; included as evaluated prescriber communications.

Record cases/ca-medical-examiner-overdose-letters.json, updated 2026-10-22· Link to this campaign