Amy S.B. Bohnert, PhD, MHS; Gery P. Guy Jr., PhD, MPH; Jan L. Losby, PhD, MSW
Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official position of the CDC.
Acknowledgment: The authors thank Dr. Grant Baldwin of the CDC, who made important contributions to a draft of this manuscript.
Financial Support: This study was supported by the CDC via employment of Drs. Guy and Losby, an intergovernmental personnel agreement with Dr. Bohnert, and costs associated with data acquisition.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1243.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Dr. Guy (e-mail, firstname.lastname@example.org). Data set: Available via licensing agreements with IQVIA.
Corresponding Author: Gery P. Guy Jr., PhD, MPH, Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F-62, Atlanta, GA 30041; e-mail, email@example.com.
Current Author Addresses: Dr. Bohnert: University of Michigan North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109.
Drs. Guy and Losby: Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F-62, Atlanta, GA 30041.
Author Contributions: Conception and design: A.S.B. Bohnert, G.P. Guy.
Analysis and interpretation of the data: G.P. Guy.
Drafting of the article: A.S.B. Bohnert, G.P. Guy, J.L. Losby.
Critical revision for important intellectual content: G.P. Guy, J.L. Losby.
Final approval of the article: A.S.B. Bohnert, G.P. Guy, J.L. Losby.
Statistical expertise: G.P. Guy.
Administrative, technical, or logistic support: G.P. Guy, J.L. Losby.
Collection and assembly of data: G.P. Guy.
In response to adverse outcomes from prescription opioids, the Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain in March 2016.
To test the hypothesis that the CDC guideline release corresponded to declines in specific opioid prescribing practices.
Interrupted time series analysis of monthly prescribing measures from the IQVIA transactional data warehouse and Real-World Data Longitudinal Prescriptions population-level estimates based on retail pharmacy data. Population size was determined by U.S. Census monthly estimates.
United States, 2012 to 2017.
Persons prescribed opioid analgesics.
Outcomes included opioid dosage, days supplied, overlapping benzodiazepine prescriptions, and the overall rate of prescribing.
The rate of high-dosage prescriptions (≥90 morphine equivalent milligrams per day) was 683 per 100 000 persons in January 2012 and declined by 3.56 (95% CI, −3.79 to −3.32) per month before March 2016 and by 8.00 (CI, −8.69 to −7.31) afterward. Likewise, the percentage of patients with overlapping opioid and benzodiazepine prescriptions was 21.04% in January 2012 and declined by 0.02% (CI, −0.04% to −0.01%) per month before the CDC guideline release and by 0.08% (CI, −0.08% to −0.07%) per month afterward. The overall opioid prescribing rate was 6577 per 100 000 persons in January 2012 and declined by 23.48 (CI, −26.18 to −20.78) each month before the guideline release and by 56.74 (CI, −65.96 to −47.53) per month afterward.
No control population; inability to determine the appropriateness of opioid prescribing.
Several opioid prescribing practices were decreasing before the CDC guideline, but the time of its release was associated with a greater decline. Guidelines may be effective in changing prescribing practices.
Bohnert AS, Guy GP, Losby JL. Opioid Prescribing in the United States Before and After the Centers for Disease Control and Prevention's 2016 Opioid Guideline. Ann Intern Med. 2018;169:367–375. doi: 10.7326/M18-1243
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Published: Ann Intern Med. 2018;169(6):367-375.
Published at www.annals.org on 28 August 2018
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