MedicalResearch.com Interview with:
Gery P. Guy Jr., PhD, MPH
Senior Health Economist
Division of Unintentional Injury
MedicalResearch.com: What is the background for this study?
Response: In response to the increasing harms and adverse outcomes from prescription opioids, the CDC released the Guideline for Prescribing Opioids for Chronic Pain in March 2016. The CDC Guideline recommends evidence-based practices for opioid use for patients age 18 years and older in primary care settings in treating chronic pain outside of active cancer treatment, palliative care, and end-of-life care.
This report analyzed the temporal changes in opioid prescribing following the release of the CDC Guideline.
MedicalResearch.com: What are the main findings?
- The release of the CDC Guideline was associated with a significantly faster rate of decline in several key opioid prescribing practices, which include the overall rate of opioid prescribing, the rate of high-dose opioid prescriptions, and the percentage of patients receiving overlapping benzodiazepine and opioid prescriptions.
- In January 2012, 6,577 opioid prescriptions were dispensed per 100,000 people; by December 2017, that number had declined to 4,240.
- 1,094,492 fewer patients received concurrent benzodiazepines and opioids prescriptions during March 2016 to December 2017 than would have been expected if pre-CDC Guidelines trends had continued.
- The report estimates that 14,195,471 fewer opioid prescriptions were filled from March 2016 to December 2017 than would have been expected if pre-CDC Guidelines trends had continued.
- An estimated 1,283,074 fewer high-dose opioid prescriptions (i.e., prescriptions for ≥ 90 MME [morphine milligram equivalent] per day) were filled from March 2016 to December 2017 than would have been expected if pre-CDC Guidelines trends had continued.
MedicalResearch.com: What should readers take away from your report?
Response: The findings in this report suggest that the release of the CDC Guideline may have contributed to improved prescribing behaviors.
Our findings suggest that clinical practice guidelines, including those where compliance is voluntary, may be able to change clinician behavior. The opioid overdose epidemic is a complex crisis that requires a response from multiple sectors, including public health, healthcare, and public safety. Interventions should be implemented in the context of a comprehensive approach that targets the drivers of the epidemic.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Further research is needed to determine the impact of specific CDC Guideline recommendations that could not be assessed in this data source, such as other patient-level outcomes (e.g., rates of opioid discontinuation and dosage tapering) and utilization of opioid use disorder treatment and non-opioid pain treatment. In addition, future research should also explore potential unintended consequences for patients, such as transition to illicit opioid use such as heroin, overdose, and suicide.
MedicalResearch.com: Is there anything else you would like to add?
Response: The CDC Guideline is available to help providers determine when and how to prescribe opioids for chronic pain. Our findings demonstrated that the CDC Guideline release was associated with decreases in key metrics of opioid prescribing.
Bohnert AS, Guy GP, Losby JL. Opioid Prescribing in the United States Before and After the Centers for Disease Control and Prevention’s 2016 Opioid Guideline. Ann Intern Med. [Epub ahead of print 28 August 2018] doi: 10.7326/M18-1243
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