Statement of Purpose To determine how the CDC Guideline for Prescribing Opioids for Chronic Pain release in 2016 coincided with changes in non-opioid pain medication prescribing.
Methods/Approach We constructed annual cohorts (2011–2018) of adults without cancer or palliative care claims, and two years of continuous insurance enrollment using the OptumInsights Clinformatics® Data Mart Database. We determined chronic pain status, prior opioid exposure, and Elixhauser comorbidity score, using the first of the two years. The primary outcome was the indicator of any non-opioid pain medication prescription fills during the second of the two years. We used conditional logistic regression models, stratified by state and adjusted for patient demographics (age, sex, insurer type) and the aforementioned clinical characteristics, to calculate the difference between the post-Guideline prescribing odds and those expected from predicted from the pre-existing secular trend.
Results In total, 14,406,303 individuals qualified for ≥1 cohort; the cohorts were majority female (varied between 51.9% and 52.8%), and the average age increased over time from 47.6 to 52.5 years. Non-opioid pain medication prescribing odds were higher among women, Medicare Advantage patients, chronic pain patients, and those with prior opioid exposure. The adjusted models estimated that non-opioid pain medication prescribing odds were 2.6% (95%CI: 2.4%-2.8%) higher in the first, 7.7% (95%CI: 7.5%-7.9%) higher in the second, and 8.1% (95%CI: 7.9%-8.3%) higher in the third year post-guideline, than predicted from the pre-guideline trend.
Conclusion Non-opioid pain medication prescribing increased following the release of the CDC Guideline, coinciding with reductions in opioid prescribing found in prior research, both of which are consistent with guideline-concordant care.
Significance Increased opioid prescribing dosage and duration is associated with increased rates of opioid-related harms. Findings presented here are consistent with prescribing practices that can reduce both overdose risk and risk of opioid use disorder.
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