Release of 2016 CDC Guideline Associated With Decrease in Opioid Prescriptions

Jason E. Goldstick, PhD

While the Centers for Disease Control and Prevention (CDC) released the “Guideline For Prescribing Opioids for Chronic Pain” in 2016, little is known about its association with prescribing patterns in patients who are considered opioid naive.

As a result, investigators, led by Jason E. Goldstick, PhD, Injury Prevention Center, University of Michigan, examined changes in initial rate of prescription, duration, and dosage practices to patients who are opioid naive after the release of the CDC guideline.

The team found trends in prescribing duration decreased after release of the guidelines, which was associated with trusted sources on prescribing practices, leaving potential to reduce opioid-related abuses.

Study

Investigators collected information from April 2011 - December 2017 to identify changes in prescribing to adults who were considered opioid naive after the release of the CDC guideline.

The study population was aged ≥18 years and received no opioid fills during a 12-month baseline, while also having data available during a 9-month follow-up period.

Eligible adults were enrolled during the 21-month period, while exclusions included anyone with cancer or palliative care claims.

The team created 4 pre guideline groups with follow-up from 2012 - 2015. Then, they constructed 2 post-guideline cohorts with follow-up periods at the end of 2016 and 2017.

Investigators quantified opioid dosage using MMEs and calculated prescription duration as the number of days covered by the prescription.

In addition, the team examined 3 outcomes including the duration of initial prescription, dosage of initial prescription (MME/day), and binary indicator of whether the initial prescription was high dose (≥50 MME/day).

Results

In the 6 cohorts, the team of investigators identified 12,870,612 individuals, with a mean age in 2016 of 51.2 years and 50.9% (n = 6,553,458) women.

They noted the size of each cohort ranged from 4,475,718 individuals in 2013 - 2014 to 5,832,088 individuals in 2016 - 2017.

Further, the mean age of each cohort had an annual increase from 48.7 years in 2011-2012 to 51.9 years in 2016-2017.

Goldstick and colleagues observed patients who were considered opioid-naive during the 9 month follow-up period decreased in each cohort.

The total in pre-guideline cohort 1 was 558,175 (11.9%) patients compared to 532,962 patients (9.1%) in post guideline cohort 2.

Patients receiving prescriptions during follow-up had an adjusted mean days’ supply 4.7% (95% CI, 4.3% - 5.1%) lower in the first year following release of the guidelines.

Further, the trend was 9.8% (95% CI, 9.3% - 10.3%) lower in the second year following release, compared with the expected rate following the pre-guideline trend.

Continuing that trend, the adjusted odds of a high-dose (≥50 MME/day) initial prescription were lower in the first year (OR 0.97; 95% CI, 0.96 - 0.98) as well as the second year (OR 0.94; 95% CI, 0.93 - 0.96) following the release of the CDC guideline compared to expectations from pre-guideline trends.

Conclusion

The data show initial opioid use prescriptions changed after the release of the CDC guideline, leading investigators to conclude evidence-based guidelines are associated with clinician behavior.

They noted that effective implementation would include the assessment of the benefit-risk profile, patient education, and risk mitigation.

“Additionally, expanding access to non-opioid therapy, including non opioid pain medications and non-pharmacologic therapies, coupled with technological innovations, such as electronic health record–based dashboards for clinicians to track pain treatment practices and outcomes for patients who are opioid naive, could help pain management,” investigators wrote. “These and other strategies to optimize guideline-concordant care have potential to improve pain management and reduce opioid-related harms.”

The study, “Changes in Initial Opioid Prescribing Practices After the 2016 Release of the CDC Guideline for Prescribing Opioids for Chronic Pain,” was published online in JAMA Network Open.