Bump in Non-Opioid Pain Prescriptions Following CDC’s 2016 Guidelines

https://www.medpagetoday.com/painmanagement/painmanagement/99183

Non-opioid pain medication prescribing increased after the CDC published guidelines on opioids for chronic pain in 2016, according to a cohort study using insurance claims data.

Among over 15 million individuals, logistic regression models showed that the odds of non-opioid pain prescriptions were higher following the release of the “Guideline for Prescribing Opioids for Chronic Pain” compared with pre-guideline pattern-based estimates:

• 3% higher in the first year (95% CI 2.6-3.3)
• 8.7% higher in the second year (95% CI 8.3-9.2)
• 9.7% higher in the third year (95% CI 9.2-10.3)

“This finding aligns with language in the 2016 CDC guideline advising caution when initiating opioids and avoiding their use as a default first-line therapy,” wrote Jason E. Goldstick, PhD, of the University of Michigan in Ann Arbor, and colleagues in JAMA Network Open.

The magnitude of the post-guideline differences from the pre-guideline pattern varied by several clinical characteristics, including chronic pain, recent opioid exposure, anxiety disorder, and mood disorder, the authors noted.

Of note, there were greater increases in odds of non-opioid prescribing over the post-guideline years among those with opioid exposure versus those without exposure:

• Year 1: OR 1.06 (95% CI 1.05-1.06) vs OR 1.02 (95% CI 1.02-1.02), respectively
• Year 2: OR 1.11 (95% CI 1.10-1.12) vs OR 1.08 (95% CI 1.08-1.09)
• Year 3: OR 1.12 (95% CI 1.11-1.13) vs OR 1.09 (95% CI 1.09-1.10)

Similarly, those with chronic pain, anxiety disorder, and mood disorders showed larger relative increases in prescribing odds of non-opioids compared with those without these factors, Goldstick and team said. For instance, those with chronic pain had a 14.9% higher prescribing rate during the third year compared with the pre-guideline pattern estimates.

In addition, non-opioid medications were more likely to be prescribed for women versus men, and those with Medicare Advantage compared with those with commercial insurance plans.

Across the study period from 2011 to 2018, opioid prescription rates notably decreased throughout the full cohort, from 23.1% in 2012 to 17.6% in 2018. Non-opioid prescriptions were steady through 2015 (20.1%), but increased in each following year, rising to 22.2% by 2018.

“Identifying the best way to tailor treatment options and delivery to the individual is a new area of investigation. Innovations in clinical research, including pragmatic and adaptive clinical trials; stepwise treatments; responder analyses; and machine learning approaches to predictive modeling of the interaction of biopsychosocial factors in response to various treatments are poised to revolutionize the field,” noted Stephanie A. Eucker, MD, PhD, of Duke University School of Medicine in Durham, North Carolina, and colleagues, writing in an invited commentary. “Until we collectively prioritize pain management to include comprehensive multimodal, person-centered treatments, the problem of chronic pain will continue to grow.”

For their study, Goldstick and colleagues constructed seven annual cohorts using claims data from the Optum Clinformatics Data Mart Database for January 2011 through December 2018. The cohorts included adults with commercial insurance or Medicare Advantage plans, no cancer or palliative care claims, and 2 years of continuous insurance enrollment. Patients were allowed to be included in more than one cohort, and each cohort covered a 2-year period.

The first year in each cohort was considered the baseline period, used to measure opioid exposures and other clinical characteristics, while the second year was the follow-up period in which prescribing outcomes were measured. Out of the seven cohorts, four were studied before the 2016 guideline was published, and three were studied after.

Goldstick and team acknowledged some limitations to their study. The requirement of continuous enrollment in an insurance plan meant that participants likely fell within a particular socioeconomic range. The study was also unable to account for pain management for those without insurance, those on Medicaid, those using over-the-counter medications, and those with a secondary insurance plan.

In addition, any comorbidities prior to a participant’s insurance coverage, as well as specialty clinic care, were not included. Some non-opioid pain medicines, such as skeletal muscle relaxants and lidocaine, were also left out of the study, they noted

Filed under: General Problems