Introduction
The Centers for Disease Control and Prevention Guideline for Prescribing Opioids for
Chronic Pain released in 2016 had led to decreases in opioid prescribing. This study
sought to examine chronic and sustained high-dose prescription opioid use in an integrated
health system.
Methods
A serial cross-sectional study was conducted in 2021 to estimate the annual age-adjusted
prevalence and incidence of chronic and high-dose opioid use among demographically
diverse noncancer adults in an integrated health system in Southern California during
2013–2020. Interrupted time-series analysis with segmented regression was conducted
to estimate changes in the trends in annual rates before (2013–2015) and after (2017–2020)
the 2016 guideline, treating 2016 as a wash-out period.
Results
Prevalence and incidence of chronic use and sustained high-dose use had started to
decrease after a health system intervention program before the 2016 Centers for Disease
Control and Prevention guideline release and continued to decline after the guideline.
Among those with sustained high-dose use, there was a substantial decrease in persons
with an average daily dosage ≥90 morphine milligram equivalent and concurrent benzodiazepine
use. An accelerated decrease in prevalent chronic use after the guideline was observed
(slope change: –11.1 [95% CI= –20.3, –1.9] users/10,000 person-years, p=0.03). The incidence of chronic use and sustained high-dose use continued to decrease
after the guideline release but at a slower pace.
Conclusions
Implementing evidence-based prescribing guidelines was associated with a decrease
in chronic and sustained high-dose prescription opioid use.
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Article info
Publication history
Published online: December 14, 2022
Identification
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© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
