Nudges to reduce opioid prescription pill burden

Project status

Pilot/study with results


Amol Navathe, MD, PhD 

Kevin Volpp, MD, PhD

Innovation leads


Donaghue Foundation 

External partners

Sutter Health System 


Drug overdose is the leading cause of injury-related death in the United States, with 91 Americans dying daily from opioid-related overdoses.    

Prescribing behaviors have been shown to contribute to this epidemic. In fact, the duration of a patient’s first opioid prescription is directly related to their likelihood of developing an addiction to opioids in the future. 


We partnered with Sutter Health System to design and implement a large-scale pragmatic trial at approximately 50 emergency departments and urgent care centers. The study was designed to explore if peer comparison feedback, individual audit feedback, or both could effectively reduce opioid prescribing in acute care settings. 


We found that peer comparison feedback, alone and combined with individual audit feedback, significantly reduced the number of pills and morphine milligram equivalents (MMEs) per opioid prescription.  

In the combined feedback arm relative to usual care, pills per prescription decreased by approximately 7 percent, and MMEs per prescription decreased by about 8 percent during the intervention period. The individual audit feedback intervention alone did not change prescribing behaviors.  

These findings demonstrate the potential of using nudges to create sustained behavior change among clinicians, and they have several implications for health systems and policymakers in ongoing work to reduce opioid overprescribing.