As opioid prescriptions decreased, nonopioid pain reliever prescriptions increased

Prescriptions for opioid pain medications decreased and prescriptions for nonopioid prescription painkillers grew after federal regulators published the 2016 guideline on using the drugs.

The federal Centers for Disease Control and Prevention published the “CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016,” with recommendations for primary care physicians who were prescribing opioids for patients with chronic pain outside 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 climbing in the preceding 10 years.

Once the guideline was published, opioid prescriptions declined and prescriptions increased for nonopioid medicines, according to a study of insurance claims data of more than 15.87 million patients across the United States. Prescriptions for nonopioids such as acetaminophen, nonsteroidal anti-inflammatory drugs, antidepressants and antiseizure drugs grew by 3% in 2016, the first year of the guideline, then by 8.7% in 2017 and by 9.7% by 2018, the third year after the CDC guideline.

“These findings suggest that clinicians have been prescribing nonopioid pain medications more frequently since the 2016 guideline was released, and that may mean that they’ve considered opioid therapy only if its expected benefits exceeded the expected risks to the patient,” lead author Jason Goldstick, PhD, said in a news release.

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

Researchers said the analysis was the first they knew of to focus on changes to nonopioid prescribing after the CDC recommendations on opioids.

Increases in nonopioid pain medication prescribing were consistent across several patient subpopulations, including patients with recent opioid exposure, anxiety or mood disorders. The changes in prescribing may have led to greater use of nonpharmacologic treatments, such as physical therapy and cognitive behavioral therapy, according to the researchers.

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

The data came 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, data focused on a population with relatively high socioeconomic status, but did not identify patient comorbidities or differences in CDC guideline implementation across regions, institutions or medical specialties, the study said.

The study, “Patterns in Nonopiod Pain Medication Prescribing After the Release of the 2016 Guideline for Prescribing Opioids for Chronic Pain,” was published in the JAMA Network Open journal.