After CDC Guidance, Little Change in Opioid Prescriptions to Those at Risk of Misuse

12/02/2020

ST. LOUIS - Research from Saint Louis University finds that among patients at risk for opioid misuse, the odds of receiving a Schedule II opioid (those with high abuse potential) for non-cancer pain were similar to those not at risk, despite new prescribing guidelines from the Centers for Disease Control (CDC).

The study, “Comparison of Opioids Prescribed for Patients at Risk for Opioid Misuse Before and After CDC Opioid Prescribing Guidelines,” by Jeffrey Scherrer, Ph.D., professor in Family and Community Medicine at SLU, was published online Dec. 2 in JAMA Network Open.

In March 2016, the CDC issued its Guideline for Prescribing Opioids for Chronic Pain. The guidance offered recommendations for opioid therapy in primary care patients with non-cancer pain. The guidelines were followed by a decline in opioid prescription rates.

This retrospective cohort study reviewed Optum de-identified electronic medical record data of 5 million adults distributed throughout the United States 18 months before and after CDC guidance was issued on March 15, 2016. Eligible patients were 18 years of age or older, did not have HIV or cancer diagnosis and had a non-cancer related painful condition that resulted in a new prescription for codeine, hydrocodone, oxycodone or tramadol.

Researchers determined if patients with benzodiazepine prescriptions, depression, anxiety or substance abuse disorders had a greater decrease in receipt of Schedule II (codeine, hydrocodone or oxycodone) versus Schedule IV (tramadol) opioids.

There were 279,435 (141,219 pre-guideline issuance and 138,216 post-guideline) eligible patients.

“Except for a 14% decrease in oxycodone prescriptions, we found no evidence for substantial changes in odds of receiving a Schedule II opioid versus tramadol in the 18 months after the CDC guidance, compared with before the guidance,” said Scherrer. 

The study was limited by the lack of data on dispensed prescriptions. Researchers were unable to determine whether prescriptions were appropriate to a patient’s pain severity and interference.

Continued education is needed, Scherrer says, to reduce prescribing of high abuse potential opioids to patients with benzodiazepine prescriptions and comorbid psychiatric and substance abuse disorders.

Takeaways

• Among patients at risk for opioid misuse, the odds of receiving a Schedule II opioid for non-cancer pain, compared to receiving tramadol, in post- versus pre-guideline periods were similar to those not at risk.
• In 18 months after CDC prescribing guidelines, compared to before the CDC prescribing guidelines, research found a 14% decrease in oxycodone prescriptions, relative to tramadol.
• There was little change in other Schedule II opioid prescribing.
• The odds of receiving hydrocodone and oxycodone versus tramadol in post and pre-guideline periods in patients with psychiatric disorders did not differ significantly from patients without psychiatric disorders.
• Schedule II opioids continue to be prescribed to high-risk patients 18 months after the CDC guideline.

The purchase of commercial electronic health records was made possible by a Saint Louis University Research Institute award to Scherrer.

Other authors include Jane Tucker, M.D., associate professor in the Departments of Family and Community Medicine at Saint Louis University; Joanne Salas, MPH, of the Department of Family and Community Medicine at Saint Louis University; Zidong Zhang, MPH, of the AHEAD Institute at Saint Louis University; and Richard Grucza, Ph.D., a professor in the Department of Family and Community Medicine at Saint Louis University.

Saint Louis University School of Medicine

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious diseases.