Do practice guidelines change behavior around opioid prescribing?

CDC guideline may have contributed to improved prescribing behavior, study finds

How much did the 2016 CDC opioid prescribing guideline for chronic pain change prescribing practices? According to a in the Annals of Internal Medicine, it may have contributed to improved prescribing behavior.

Although several opioid prescribing practices were already decreasing before the CDC guideline came out, researchers of the study were able to determine that the timing of the release of the guideline was associated with a significantly faster rate of decline in several key opioid prescribing practices, including the overall rate of opioid prescribing, the rate of high-dose opioid prescriptions dispensed, and the percentage of patients receiving overlapping benzodiazepine and opioid prescriptions. For instance, in January 2012, 6,577 opioid prescriptions were dispensed per 100,000 persons; by December 2017, that number had declined to 4,240, according to the findings in the study. Researchers also estimated that 14,195,471 fewer opioid prescriptions were filled from March 2016 to December 2017 than would have been expected if pre-CDC guideline trends had continued.

“Our findings suggest that clinical practice guidelines, including those where compliance is voluntary, may be able to change clinician behavior,” said Gery Guy, PhD, MPH, CDC’s Division of Unintentional Injury Prevention.

Guy noted, however, that increased attention to the problem during the study period likely influenced prescribing in ways that are challenging to distinguish from any potential effect from the CDC guideline. Additionally, the research wasn’t able to take into account the appropriateness of prescribing for a given patient because indications for the opioid—like if it was for acute pain, chronic pain, cancer, or palliative care—were unavailable, according to Guy.

CDC’s Guideline for Prescribing Opioids for Chronic Pain, released in March of 2016, recommended evidence-based practices for opioid use for patients 18 years and older in primary care settings in treating chronic pain outside of active cancer treatment, palliative care, and end-of-life care.