Government Direct-to-Consumer Education to Reduce Prescription Opioid Use: A Cluster Randomized Clinical Trial
ABSTRACT
Importance: Direct-to-consumer education has been effective in reducing chronic sedative use, but its effectiveness for prescription opioids among patients with chronic noncancer pain has not been tested.
Objectives: This trial aimed to evaluate the effectiveness of a government-led educational information brochure mailed to community-dwelling, long-term opioid consumers to reduce prescription opioid use compared with usual care.
Design, Setting, and Participants: The trial was conducted in Manitoba, Canada, from July 2018 to January 2019, enrolling 4225 adults with long-term opioid prescriptions. Participants were identified via the Manitoba Drug Program Information Network, with exclusions for individuals receiving palliative care or with a diagnosis of cancer or dementia.
Intervention: Participants were clustered according to their primary care clinic and randomized to receive the intervention (a direct-to-consumer educational brochure sent by mail) or usual care (comparator group).
Main Outcomes and Measures: The main outcome was discontinuation of opioid prescriptions at the participant level after 6 months, with secondary outcomes including dose reduction and/or therapeutic switch. Analysis was intention to treat.
Results: After 6 months, no significant difference in the prevalence of opioid cessation was observed between the intervention and usual care groups; however, the intervention resulted in more adults reducing their opioid dose compared with usual care.
Conclusions and Relevance: The trial found that the intervention did not significantly increase the prevalence of opioid cessation after 6 months, but it did result in more adults reducing their opioid dose compared with usual care.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03400384.
PMID: 38809554 | DOI: 10.1001/jamanetworkopen.2024.13698
