Did Updated CDC Guidelines for Opioid Use in Chronic Pain Change Prescribing?

The 2016 guidelines from the US Centers for Disease Control and Prevention (CDC) which aimed to reduce the amount of prescribed opioids for  chronic pain was associated with a substantial reduction in opioid prescriptions. These findings were published in Health Affairs.

This interrupted time series analysis sourced data from Optum’s Clinformatics Data Mart database. Patients aged <65 years with documented chronic, noncancer pain (fibromyalgia, headache, osteoarthritis, back, or neck pain) were assessed for prescribed opioids between 2014 and 2018. The pre-guideline period was defined as March 2014-November 2015 and post-guideline period as July 2016-December 2018. Dispensation of benzodiazepines for anxiety or non-pain-related diagnoses during the same time periods was used as a negative control.

This study cohort was comprised 361,515 individuals with osteoarthritis or back/neck pain and 169,487 individuals with fibromyalgia or headache. Overall, the study population was aged mean 47.5 years, 58.7% were women, 71.6% were White, 10.1% Hispanic, 9.0% Black, they had 1.7 pain-related visits per month, the morphine milligram equivalents (MME) was 64.6, and 19.8% were receiving >90 MME.

Comparing the pre- and post-guideline periods, after the CDC’s guideline, the average opioid dose was decreased by 15.1 (95% CI, 10.74-19.35) MME. The decrease in MME was greater among patients with osteoarthritis or back/neck pain (mean difference [MD], 15.6; 95% CI, 11-20.16 MME) than for those with fibromyalgia or headache (MD, 10.6; 95% CI, 1.73-19.53 MME).

Among the subset of patients using high-dose opioids (n=11,853), the decrease in dosage was similar among patients with osteoarthritis or back/neck pain (n=11,016; MD, 7.6%; 95% CI, 6.39%-8.81% MME) and those with fibromyalgia or headache (n=1554; MD, 7.5%; 95% CI, 5.11%-10.01% MME).

A different trend was observed for the cohort of patients with concurrent opioids and benzodiazepines (n=11,867), in which the decrease in dosage was observed among patients with osteoarthritis or back/neck pain (n=11,033; MD, 29.6%; 95% CI, 21.44%-37.72% MME) and no different was observed for those with fibromyalgia or headache (n=1555; MD, 3.7%; 95% CI, -4.03% to 11.36% MME).

The number of days supplied with opioids decreased after the guideline by 4.3 (95% CI, 3.56-5.01) days among the entire study cohort. Among the subset of individuals with concomitant benzodiazepine use (n=2229), no significant difference was observed (MD, 6.4; 95% CI, -1.36 to 14.07 days).

This study was limited by not having a control equivalent, as the guideline went into effect nationally. However, the investigators used a negative control in an attempt to provide some controlled reference for these data.

This study found that the 2016 guideline from the CDC likely contributed to the substantial decrease in the intensity of opioid prescriptions among patients with chronic pain. However, additional study is needed to assess whether the strength of specific recommendations had an effect on real-world opioid prescribing.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Townsend T, Cerdá M, Bohnert A, Lagisetty P, Haffajee RL. CDC guideline for opioid prescribing associated with reduced dispensing to certain patients with chronic pain. Health Aff. 2021;40(11):1766-1775. doi:10.1377/hlthaff.2021.00135