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Comparison of Opioids Prescribed for Patients at Risk for Opioid Misuse Before and After Publication of the Centers for Disease Control and Prevention's Opioid Prescribing Guidelines.
JAMA Netw Open. 2020 12 01; 3(12):e2027481.JN

Abstract

Importance

It is not known whether decreases in Schedule II (high abuse potential) vs Schedule IV (lower abuse potential) opioid prescriptions overall and among high-risk patients followed publication of the Centers for Disease Control and Prevention (CDC) opioid prescribing guideline on March 15, 2016.

Objectives

To compare the odds of new Schedule II opioid (codeine, hydrocodone, oxycodone) prescriptions vs Schedule IV opioid (tramadol) prescriptions in the 18-month periods before and after the CDC guideline release to determine whether new prescriptions for Schedule II opioids decreased relative to new prescriptions for tramadol and to assess whether patients with benzodiazepine prescriptions or those with depression, anxiety, or substance use disorders had a greater decrease in receipt of Schedule II vs Schedule IV opioids.

Design, Setting, and Participants

Cross-sectional study of Optum's deidentified Integrated Claims-Clinical data set for 5 million US adults 18 months before and 18 months after March 15, 2016. Eligible patients were 18 years or older, free of HIV and cancer diagnoses, and had a noncancer painful condition. Patients received new prescriptions for codeine, hydrocodone, oxycodone, or tramadol. Data were analyzed from September 5, 2014, to September 14, 2017.

Exposure

The CDC opioid prescribing guideline published on March 15, 2016.

Main Outcomes and Measures

The odds of prescriptions for each Schedule II opioid vs tramadol after guideline publication.

Results

Data from 279 435 patients were included in the study. The mean (SD) age of patients was 52.9 (16.5) years; 61% were female and 79.4% were White. The prevalence of new prescriptions for each drug before and after guideline publication was as follows: codeine, 7.1% vs 7.0%; hydrocodone, 47.4% vs 45.6%; oxycodone, 22.4% vs 24.0%; and tramadol, 23.0% vs 23.4%. Overall, the odds of being prescribed hydrocodone or oxycodone vs tramadol significantly decreased after guideline publication (odds ratios, 0.95; 95% CI, 0.91-0.98 and 0.86; 95% CI, 0.82-0.90, respectively). Odds of being prescribed a Schedule II opioid vs tramadol after vs before guideline publication were similar in patients with and without benzodiazepine comedication or psychiatric disorders.

Conclusions and Relevance

In the 18 months after compared with the 18 months before publication of the CDC prescribing guideline, a 14% decrease in oxycodone prescriptions was observed relative to tramadol. Little change in prescriptions of other Schedule II opioids was observed. Schedule II opioids continue to be prescribed to high-risk patients 18 months after publication of the CDC guideline.

Authors+Show Affiliations

Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri.Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri.Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri.Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri.Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33263762

Citation

Scherrer, Jeffrey F., et al. "Comparison of Opioids Prescribed for Patients at Risk for Opioid Misuse Before and After Publication of the Centers for Disease Control and Prevention's Opioid Prescribing Guidelines." JAMA Network Open, vol. 3, no. 12, 2020, pp. e2027481.
Scherrer JF, Tucker J, Salas J, et al. Comparison of Opioids Prescribed for Patients at Risk for Opioid Misuse Before and After Publication of the Centers for Disease Control and Prevention's Opioid Prescribing Guidelines. JAMA Netw Open. 2020;3(12):e2027481.
Scherrer, J. F., Tucker, J., Salas, J., Zhang, Z., & Grucza, R. (2020). Comparison of Opioids Prescribed for Patients at Risk for Opioid Misuse Before and After Publication of the Centers for Disease Control and Prevention's Opioid Prescribing Guidelines. JAMA Network Open, 3(12), e2027481. https://doi.org/10.1001/jamanetworkopen.2020.27481
Scherrer JF, et al. Comparison of Opioids Prescribed for Patients at Risk for Opioid Misuse Before and After Publication of the Centers for Disease Control and Prevention's Opioid Prescribing Guidelines. JAMA Netw Open. 2020 12 1;3(12):e2027481. PubMed PMID: 33263762.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Opioids Prescribed for Patients at Risk for Opioid Misuse Before and After Publication of the Centers for Disease Control and Prevention's Opioid Prescribing Guidelines. AU - Scherrer,Jeffrey F, AU - Tucker,Jane, AU - Salas,Joanne, AU - Zhang,Zidong, AU - Grucza,Richard, Y1 - 2020/12/01/ PY - 2020/12/2/entrez PY - 2020/12/3/pubmed PY - 2021/1/28/medline SP - e2027481 EP - e2027481 JF - JAMA network open JO - JAMA Netw Open VL - 3 IS - 12 N2 - Importance: It is not known whether decreases in Schedule II (high abuse potential) vs Schedule IV (lower abuse potential) opioid prescriptions overall and among high-risk patients followed publication of the Centers for Disease Control and Prevention (CDC) opioid prescribing guideline on March 15, 2016. Objectives: To compare the odds of new Schedule II opioid (codeine, hydrocodone, oxycodone) prescriptions vs Schedule IV opioid (tramadol) prescriptions in the 18-month periods before and after the CDC guideline release to determine whether new prescriptions for Schedule II opioids decreased relative to new prescriptions for tramadol and to assess whether patients with benzodiazepine prescriptions or those with depression, anxiety, or substance use disorders had a greater decrease in receipt of Schedule II vs Schedule IV opioids. Design, Setting, and Participants: Cross-sectional study of Optum's deidentified Integrated Claims-Clinical data set for 5 million US adults 18 months before and 18 months after March 15, 2016. Eligible patients were 18 years or older, free of HIV and cancer diagnoses, and had a noncancer painful condition. Patients received new prescriptions for codeine, hydrocodone, oxycodone, or tramadol. Data were analyzed from September 5, 2014, to September 14, 2017. Exposure: The CDC opioid prescribing guideline published on March 15, 2016. Main Outcomes and Measures: The odds of prescriptions for each Schedule II opioid vs tramadol after guideline publication. Results: Data from 279 435 patients were included in the study. The mean (SD) age of patients was 52.9 (16.5) years; 61% were female and 79.4% were White. The prevalence of new prescriptions for each drug before and after guideline publication was as follows: codeine, 7.1% vs 7.0%; hydrocodone, 47.4% vs 45.6%; oxycodone, 22.4% vs 24.0%; and tramadol, 23.0% vs 23.4%. Overall, the odds of being prescribed hydrocodone or oxycodone vs tramadol significantly decreased after guideline publication (odds ratios, 0.95; 95% CI, 0.91-0.98 and 0.86; 95% CI, 0.82-0.90, respectively). Odds of being prescribed a Schedule II opioid vs tramadol after vs before guideline publication were similar in patients with and without benzodiazepine comedication or psychiatric disorders. Conclusions and Relevance: In the 18 months after compared with the 18 months before publication of the CDC prescribing guideline, a 14% decrease in oxycodone prescriptions was observed relative to tramadol. Little change in prescriptions of other Schedule II opioids was observed. Schedule II opioids continue to be prescribed to high-risk patients 18 months after publication of the CDC guideline. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/33263762/Comparison_of_Opioids_Prescribed_for_Patients_at_Risk_for_Opioid_Misuse_Before_and_After_Publication_of_the_Centers_for_Disease_Control_and_Prevention's_Opioid_Prescribing_Guidelines_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.27481 DB - PRIME DP - Unbound Medicine ER -