CDC Guideline for Opioid Prescribing May Have Effectively Reduced Opioid Prescribing Practices

The Centers for Disease Control and Prevention’s (CDC) Guideline for Prescribing Opioids for Chronic Pain released in March 2016 may have contributed to a further reduction in several opioid prescribing practices, according to a study published in the Annals of Internal Medicine.

An interrupted time series analysis of monthly opioid prescribing practices in the United States between 2012 and 2017 was conducted using the IQVIA transactional data warehouse and the Real-World Data Longitudinal Prescriptions population-level estimates, which are based on retail pharmacy data. Study outcomes based on 6 of the 12 CDC guideline recommendations for opioid prescribing were rate of high-dosage opioid prescriptions (≥90 morphine equivalent milligrams [MME] per day), average MME per capita, average daily MME per prescription, percentage of ≤3 prescriptions with ≤7 days supplied, overall prescription rate, and overall opioid prescribing rates.

In January 2012, the rate of high-dosage prescriptions was 683 per 100,000 people. Immediately before the publication of the CDC recommendations, the rate of high-dosage opioid prescribing decreased to 3.56 (95% CI, −3.79 to −3.32) per month and by 8.00 (95% CI, −8.69 to −7.31) after publication of the guideline. 

The percentage of patients with overlapping benzodiazepine and opioid prescriptions declined from 21.04% in January 2012 to 0.02% per month (95% CI, −0.04% to −0.01%) before publication of the guideline and by 0.08% per month (95% CI, −0.08% to −0.07%) thereafter. The rate of overall opioid prescribing also decreased from 6577 per 100,000 persons in January 2012 to 23.48 per month (95% CI, −26.18 to −20.78) before publication and by 56.74 per month (95% CI, −65.96 to −47.53) after the release of the guideline.

The lack of a comparison population and the absence of information on provider and patient characteristics represent 2 study limitations.

“The opioid overdose epidemic is a complex crisis that requires a response from several sectors, including public health, health care, and public safety,” the investigators noted. “These findings suggest that the guideline release may have contributed to better prescribing behaviors.”

Bohnert ASB, Guy GP Jr, Losby JL. Opioid prescribing in the United States before and after the Centers for Disease Control and Prevention’s 2016 opioid guideline [published online August 28, 2018]. Ann Intern Med. doi:10.7326/M18-1243