Statement of Purpose In 2016, the CDC released the Guideline for Prescribing Opioids for Chronic Pain. The guideline recommends using the lowest effective dose when opioids are started. We assessed changes in initial prescribing doses following the release of the CDC Guideline.

Methods/Approach We used data from the OptumInsights database (1/2012–6/2017), which contains all claims made by commercial and Medicare Advantage beneficiaries enrolled with UnitedHealth. We restricted to enrollees age ≥18 years (consistent with the intended patient population of the CDC Guideline), which comprises ∼7.7% of US adults. We created a cohort of opioid naïve individuals (no opioid fills for twelve months) pre-guideline that were continuously enrolled through 6/2017 (fifteen months post-guideline). To establish the pre-guideline trend, we constructed three analogous control groups, but shifted back 1, 2, and 3 years, respectively. Statistical analyses focused on the difference between observed post-guideline initial high-dose (≥50 MME/day) prescribing rates, and those predicted from the pre-existing trend. We derived adjusted effects using logistic regression adjusted for age, sex, race, insurer type, as well as state and time fixed effects.

Results There were 6,276,020 beneficiaries across the four cohorts, 792,591 (12.6%) of whom received a prescription opioid during their follow-up. Among those initiating opioids post-guideline, 18.7% were started with high-dose prescriptions, lower than the 19.8% predicted by the pre-existing trend. Adjusted analyses confirmed that the post-guideline cohort had a 6.3% (95%CI: 4.1%-8.3%) lower odds of high-dose initiation than expected. Sensitivity analyses around the 50MME/day threshold showed post-guideline dosage changes were primarily reflected in lowering moderate/high dosages (40–60 MME/day) to ≤40 MME/day.

Conclusions Changes in high-dose initial prescribing seen following release of the CDC guideline could not be explained by pre-existing secular trends.

Significance/Contribution to Injury Science Safer opioid prescribing has great potential to reduce injuries and other harms incurred by opioid misuse.