Downward trend of prescribing less potent opiates since CDC guideline

Aug. 12, 2021

Five years ago, with an epidemic of opioid-involved overdoses escalating, the Centers for Disease Control and Prevention (CDC) released an evidence-based guideline for doctors aimed at helping them treat their patients’ pain while balancing the risks and benefits of prescription opioid medications.

Now, a new study from the University of Michigan suggests the CDC Guideline for Prescribing Opioids for Chronic Pain may have started to have an effect in the first two years after its launch. The study focuses on opioid prescriptions that were filled by patients who had not used their insurance in the past year to fill any other opioid prescription before and after the 2016 guideline release.

While there was actually a small increase in the percentage of such patients who received opioids, those who did receive opioids had different trends in two ways: the number of days’ supply of opioids in their prescriptions, and the dose.

Specifically, after the guideline’s release, initial opioid prescribing among these “opioid naïve” patients showed decreases in both the average days’ supply, and in the likelihood that their initial prescription would be for doses larger than 50 MME (morphine milligram equivalents), compared with what would be expected from the pre-guideline trends.

The researchers make it clear that they cannot attribute any one change or trend to the CDC’s guideline, say the University of Michigan researchers who led the analysis published in JAMA Network Open. But the CDC opioid prescribing guideline may be a critical part of a broader catalyzation of actions taken by prescribers, they say.

The new findings add to a body of evidence that can inform efforts to revise evidence-based opioid prescribing guidelines and decrease the chance that they will be misapplied. For instance, the 2016 guideline was not intended to apply to patients with cancer, major surgical pain, and those in hospice or palliative care. Yet prescribing patterns for those populations have been shown in other studies to have changed since the guideline was issued.

The percentage of these “opioid-naïve” patients filling an opioid prescription dropped from nearly 12% in the first year to just over 9% in the final year – and the decline was already well under way before the guideline came out. The percentage of patients filling opioid prescriptions after the guideline came out was slightly higher than the downward trend from the previous few years would have predicted – enough to be statistically significant.

The number of days’ supply contained in the initial prescriptions filled by the patients was increasing before the CDC guideline came out – even as the percentage of patients filling at least one prescription dropped. But the duration of prescriptions dropped by 5% in the first year and 10% in the second year after the CDC guideline was published.

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