Discussion
death, overdose
This randomized clinical trial found that opioid prescribing continued to decrease well after receipt of a letter notifying the clinician of a fatal overdose. Awareness of being observed, an injunction from authority, and the availability of harm may explain this effect. The intervention was delivered at a low cost. This study did not address the alarming acceleration of fatal overdoses by illicit fentanyl. Considering the changing pandemic-related causes of death, future research should assess patient-reported outcomes and determine whether such letters could encourage medication-assisted therapy initiation.