December 29, 2025-- A new randomized clinical trial finds that simple reminder emails substantially increase clinicians' use of a database that supports safe prescribing of opioids and other drugs, even though opioid prescribing patterns themselves did not meaningfully change during the study period. The study was led by researchers at Columbia University Mailman School of Public Health and the University of Southern California. The findings are published in JAMA Health Forum.
The databases, called Prescription Drug Monitoring Programs (PDMPs), track prescribing of opioids and other tightly regulated medications. All U.S. states operate PDMPs, and most require clinicians to make accounts and check the system before prescribing opioids. Yet compliance remains uneven, an ongoing concern of policymakers.
"Our study shows that e-mails can encourage clinicians to make accounts and check their state's prescription drug monitoring program," said Adam Sacarny, PhD, associate professor of Health Policy and Management at Columbia Mailman School of Public Health and principal investigator of the study. "We think these results are exciting because these databases can help clinicians prescribe safely, but many clinicians still don't use them."
In the new study, researchers collaborated with the Minnesota state government to build evidence on low-cost interventions to make prescribing safer. They focused on 7,872 physicians and physician assistants who were not meeting state requirements to hold a PDMP account or search the system before prescribing. Clinicians were randomly assigned to one of three groups: e-mails emphasizing the state's legal requirements to use the PDMP, e-mails focusing on clinical guidelines and PDMP use, and a control group that was not sent e-mails. The researchers then tracked use of the PDMP and prescribing.
Both types of emails significantly increased PDMP engagement, including account creation, searching, and searching for patients with a history of risky prescribing. Emails emphasizing legal requirements more than tripled engagement. Emails highlighting clinical benefits were also effective, but less so: they more than doubled engagement. However, neither email had detected effects on prescribing.
"The legal requirement emails were particularly encouraging because they led one in four clinicians to use the PDMP who otherwise would not have," said Mireille Jacobson, PhD, the study's last author and professor of Gerontology and Public Policy at the University of Southern California. "Although the emails did not change opioid prescribing, just getting clinicians to make PDMP accounts and check the PDMP could still translate to safer and better-informed care for patients."
Data came from the Minnesota PDMP and included all controlled-substance prescriptions dispensed statewide. Prescribing behavior and PDMP use were tracked for seven months following the first email. The effects on PDMP use were durable, persisting for at least the seven-month period after the initial email.
The findings build on earlier work by Sacarny and colleagues showing that simple messages can effectively promote PDMP use. In the prior study, which sent clinicians mailed letters rather than emails, messages emphasizing legal obligations also outperformed clinically framed messages—and neither approach altered prescribing.
"Email is a low-cost, scalable intervention that meaningfully increases PDMP engagement, especially when legal requirements are emphasized," Sacarny said. "These interventions could serve as templates for efforts to promote other best practices in health care, too."
"Our approach is backed by randomized trial evidence and can be easily translated to other contexts," Sacarny added. "The results should be useful and encouraging for policymakers, health systems, and organizations focused on safer prescribing and patient safety."
In addition to Sacarny and Jacobson, co-authors are Tatyana Avilova, Secretariat; and Ian Williamson and Weston Merrick, Minnesota Management and Budget Agency.
The study was supported by the Abdul Latif Jameel Poverty Action Lab. Dr. Sacarny has no financial conflicts of interest. See the paper for other co-author financial disclosure information.
Columbia University Mailman School of Public Health
