Association of the “CDC Guideline for Prescribing Opioids for Chronic Pain” With Emergency Department Opioid Prescribing

Dayer, Lindsey; Breckling, Meghan N.; Kling, Brittanie S.; Lakkad, Mrinmayee; McDade, Elizabeth R; Painter, Jacob T.

doi:10.1016/j.jemermed.2019.07.016

Cited by 16 publications

(31 citation statements)

References 14 publications

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“…Of these, 180 were kept for full-text review, and 63 unique studies were included in the review ( Figure 1 ). 12 , 27 , 28 , 29 , 30 , 31 , 32 , 35 , 36 , 37 , 39 , 40 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , …”

Section: Resultsmentioning

confidence: 99%

“… 69 , 94 , 102 All studies were published within the last 10 years (2013 to 2021). Studies used mainly preintervention-postintervention (n = 39) 12 , 28 , 30 , 31 , 32 , 35 , 39 , 40 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 92 , 93 , 94 , 99 , 100 , 101 , 102 and ITS (n = 21) 27 , 29 , 36 , 37 , 54 , 55 , 56 , 57 , 71 , 72 , 73 , 74 , 87 , 88 , 89 , 90 , 91 , ...…”

Section: Resultsmentioning

confidence: 99%

“… 103 , 104 The EPG intervention was used to help reduce opioid prescriptions in 21 studies 31 , 32 , 35 , 36 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ; PDMP, in 19 studies 27 , 28 , 29 , 30 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ; EMR-QC, in 11 studies 37 , 39 , 40 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 ; CPC, in 10 studies 12 , 86 , 87 , 88 , 89 , 90 , …”

Section: Resultsmentioning

confidence: 99%

“… 22 , 23 Several opioid reduction strategies have been proposed by medical institutions, cities, states, and other stakeholders. These approaches vary extensively, ranging from prescription drug monitoring programs, 24 , 25 , 26 , 27 new laws, 28 , 29 , 30 policies, guidelines, 31 , 32 , 33 , 34 prescriber education initiatives, 35 , 36 or changing the default quantity of opioids in electronic medical record prescription orders. 37 , 38 , 39 , 40 The efficacy of these interventions on the opioid prescribing rate or quantity at ED discharge remains uncertain and, to our knowledge, has never been examined systematically.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Interventions to Reduce Opioid Prescribing for Patients Discharged From the Emergency Department

et al. 2022

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Key Points Question Are interventions to reduce pain-related opioid prescribing for patients who are discharged from the emergency department associated with variation in opioid prescription rate and/or prescribed opioid quantity? Findings In this meta-analysis of 63 unique studies, 34 of 51 studies assessing prescribing rates (67%) reported a significant reduction after intervention implementation, and 17 of the 39 studies assessing prescribed opioid quantity (44%) reported a significant intervention-related reduction. There were no data on patient-centered outcomes such as pain relief. Meaning This analysis found that specific interventions may be associated with reducing the opioid prescription rate; however, novel interventions are needed to reduce the quantity of opioids per prescription by emergency department physicians while evaluating their associations with patient-centered outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of Interventions to Reduce Opioid Prescribing for Patients Discharged From the Emergency Department

et al. 2022

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“…A systematic review demonstrated that approximately one in ten adults in the general population report experiencing chronic widespread pain, and found that this experience is especially prevalent among women [ 2 ]. The treatment of chronic widespread pain is rather difficult, considering inadequate biomedical diagnoses, and recent concerns surrounding opioid therapies for chronic pain, including risk of opioid use disorder and overdose [ 3 , 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

The Association of Pain Levels and Low Physical Activity among Older Women

et al. 2021

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There is an integral research gap regarding whether there is a relationship between pain levels and low physical activity among older women. This is a secondary analysis of a longitudinal cohort study, the Women’s Health and Aging Study (WHAS) II. Our analyses included 436 community-dwelling women between the ages of 70 and 79, who were followed for 10.5 years. We employed marginal structural modeling, which controls for time-dependent confounding, with the aim of assessing the potential direct association between pain levels and low physical activity and assess a graded relationship. Compared to women with no pain, those with widespread pain were nearly half as likely to be moderately active versus low active (aOR: 0.46, 95% confidence interval (CI): 0.22, 0.96). A graded association was observed across the four pain levels (no pain or mild pain, other pain, moderate or severe lower extremity pain, and widespread pain) on low physical activity. Our findings indicate that reducing chronic widespread pain in older women may increase moderate physical activity, and therefore reduce the downstream health risks of physical inactivity, including morbidity and mortality risk.

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Opioid Prescribing and Outcomes in Patients With Sickle Cell Disease Post–2016 CDC Guideline

Kang,

Wang,

Barner

et al. 2024

JAMA Intern Med

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ImportanceAlthough the intention of the 2016 US Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain was not to limit pain treatment for patients with sickle cell disease (SCD), clinicians and patients have recognized the possibility that the guideline may have altered outcomes for this population. However, the outcomes of the 2016 guideline for this patient population are unknown.ObjectiveTo examine changes in opioid prescribing patterns and health outcomes among patients with SCD before and after the release of the 2016 CDC guideline.Design, Setting, and ParticipantsThis retrospective cohort study conducted interrupted time series analysis of claims data from the Merative MarketScan Commercial Database from January 1, 2011, to December 31, 2019. In this population-based study in the US, individuals with SCD who were at least 1 year of age, had no cancer diagnosis, and had pharmacy coverage for the month of measurement were included. The data were analyzed from January 2021 to November 2023.ExposureThe CDC Guideline for Prescribing Opioids for Chronic Pain released in March 2016.Main Outcomes and MeasuresThe main variables measured in this study included the practice of opioid prescribing among patients with SCD (ie, rate of opioid prescriptions dispensed, mean number of days supplied, mean total morphine milligram equivalents [MME] per patient, and mean daily MME per opioid prescription) and pain-related health outcomes (rates of emergency department visits related to vaso-occlusive crises [VOC] and hospitalizations related to VOC).ResultsThe cohort included 14 979 patients with SCD (mean [SD] age, 25.9 [16.9] years; 8520 [56.9%] female). Compared with the preguideline trends, the following changes were observed after the guideline was released: significant decreases in the coefficient for change in slope of the opioid dispensing rate (−0.29 [95% CI, −0.39 to −0.20] prescriptions per 100 person-month; P &lt; .001), the number of days supplied per prescription (−0.05 [95% CI, −0.06 to −0.04] days per prescription-month; P &lt; .001), and opioid dosage (−141.0 [95% CI, −219.5 to −62.5] MME per person-month; P = .001; −10.1 [95% CI, −14.6 to −5.6] MME/prescription-month; P &lt; .001). Conversely, a significant increase in VOC-related hospitalizations occurred after the guideline release (0.16 [95% CI, 0.07-0.25] hospitalizations per 100 person-month; P = .001). These changes were observed to a greater extent among adult patients, but pediatric patients experienced similar changes in several measures, even though the guideline focused exclusively on adult patients.Conclusions and RelevanceThis retrospective cohort study showed that the 2016 CDC guideline may have had unintended negative outcomes on the patient population living with SCD.

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Association of the “CDC Guideline for Prescribing Opioids for Chronic Pain” With Emergency Department Opioid Prescribing

Cited by 16 publications

References 14 publications

Evaluation of Interventions to Reduce Opioid Prescribing for Patients Discharged From the Emergency Department

Evaluation of Interventions to Reduce Opioid Prescribing for Patients Discharged From the Emergency Department

The Association of Pain Levels and Low Physical Activity among Older Women

Opioid Prescribing and Outcomes in Patients With Sickle Cell Disease Post–2016 CDC Guideline

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