NOBLESVILLE, Ind. – Cutting opioid use could be as simple as writing a letter.

National Institute on Drug Abuse deputy director Wilson Compton says the goal isn’t to eliminate opioid painkillers — he says they’re a critical part of treatment. But he told Indiana’s annual drug abuse conference the agency is working to encourage doctors to consider alternatives to opioids, and to think before writing prescriptions. He says nine out of 10 doctors have written refill prescriptions even after a patient has overdosed. One out of six of those patients O-D’d again.

Compton says one simple approach has made a noticeable difference: a letter to doctors from the county coroner explaining the risks. A study last year found doctors receiving those letters reduced opioid prescriptions by nine-percent.

The rise of opioid abuse has been steep, especially fentanyl. Compton says it’s so cheap to make that dealers can sell it for a thousand times their cost. It’s now almost as prevalent as heroin and prescription drug abuse combined.

Compton says the opioid epidemic hasn’t displaced methamphetamine use, but worsened it. In six years, heroin treatment clinics have seen a doubling of the percentage of patients who also use meth. Compton says it’s difficult to study the effect on humans, but a study of mice found the combo 70-percent deadlier than heroin alone.

Along with dialing back prescriptions, Compton emphasizes the importance of medically-assisted treatment with drugs like methadone and buprenorphine, and educating teenagers about drug abuse so they don’t become part of the epidemic as adults.