As opioid prescriptions decreased, non-opioid painkiller prescriptions increased

Prescriptions for opioid pain relievers declined and prescriptions for non-opioid prescription pain relievers increased after federal regulators issued the 2016 drug use guideline.

The Federal Centers for Disease Control and Prevention released the “CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016”, with recommendations for primary care physicians who prescribe opioids to patients with chronic pain. of chronic pain outside of active cancer treatment, palliative care and end-of-life care. The guideline acknowledged “serious risks, including overdose and opioid use disorder”, with overdose death rates increasing over the previous 10 years.

After the guideline was released, prescriptions for opioids went down and prescriptions for non-opioid drugs went up, according to a study insurance claims data from over 15.87 million patients across the United States. Prescriptions of non-opioids such as acetaminophen, nonsteroidal anti-inflammatory drugs, antidepressants and anticonvulsants increased by 3% in 2016, the first year of the guideline, then by 8.7% in 2017 and by 9 .7% in 2018, the third year after the CDC. guideline.

“These results suggest that clinicians are prescribing non-opioid pain relievers more frequently since the 2016 guideline was published, and this may mean that they only considered opioid treatment if its expected benefits outweighed the expected risks to the patient.” , lead author Jason Goldstick, PhD, said in a Press release.

“Although many characteristics – such as pain intensity and effectiveness of pain management – ​​are not available in these data, these results may represent a guideline-compliant increase in pain treatment,” said Goldstick, associate research professor of emergency medicine at the University of Michigan. Medicine School.

The researchers said the analysis was the first to their knowledge to focus on changes to nonopioid prescribing after the CDC’s opioid recommendations.

Increases in the prescription of non-opioid pain relievers were consistent across multiple patient subpopulations, including patients with recent opioid exposure, anxiety, or mood disorders. Changes in prescribing may have led to greater use of non-pharmacological treatments, such as physical therapy and cognitive-behavioral therapy, the researchers said.

“The 2016 guideline encouraged caution in prescribing opioids, and it was possible that it may have reduced the use of pain treatments overall,” said lead author Amy Bohnert, PhD. MHS, in the press release. Bohnert is an associate professor of psychiatry at UM Medical School. “Our analysis provides an encouraging sign that patients were being offered other pain treatments more often than before the guideline, rather than being offered opioids less often.”

Data is from the national Optum Clinformatics Data Mart database from 2011 to 2018 for patients with at least two years of continuous coverage. Coming from a single national insurer, the data focused on a population of relatively high socioeconomic status, but did not identify patient comorbidities or differences in implementation of CDC guidelines between regions, institutions or medical specialties, depending on the study.

The study, “Patterns of prescribing non-opioid pain medications after the release of the 2016 guideline on prescribing opioids for chronic pain,” was published in the Open JAMA Network log.