Background: The 2016 Center for Disease Control (CDC) opioid prescribing guidelines recommend the use of non-opioid pharmacologic therapy when effective alternatives are available. While the effect of the CDC guidelines on overall opioid prescribing has been tested, limited data exist on the impact among patients with chronic low back pain (CLBP).
Objectives: To evaluate the hypothesis that the 2016 CDC guidelines corresponded to a decrease in the prescribing and duration of opioid treatment among patients with CLBP.
Methods: Patients (age ≥ 18 years) with ≥ 2 diagnoses for CLBP ≥90 days apart were selected from Optum’s de-identified Clinformatics® Data Mart Database. For each month during a three year period before (March 18, 2013 – March 17, 2016) and after (March 18, 2016 – March 17, 2019) the release of the CDC guidelines, the rate of incident opioid prescriptions was evaluated, defined as any opioid prescription during the month of interest with no opioid during the year prior. Continuous enrollment during the month of interest and 12 months prior were required for patients to be included in each monthly analysis. Furthermore, incident prescriptions were required to have no evidence of surgery during the 12 weeks prior to prescription date. For all incident prescriptions in each month, time to discontinuation was evaluated and summarized per 1000 patients. Interrupted time series analysis was used to estimate the slope change in opioid initiation and treatment duration in the three years pre- and post-guideline release, controlling for seasonality.
Results: The incidence rate of opioid prescriptions was 7.55 per person-year in March 2013 and decreased to 4.22 per person-year by March 2019 among patients with CLBP. A small but significant decrease in the slope of monthly incidence was observed following the release of the CDC guidelines, with a 0.3% decrease in the post-intervention period (-0.003; 95% CI -0.006, -0.0004). Similarly, the average treatment duration for incident prescriptions declined from 57.47 days to 46.08 days over the study period, with increasing decline after the release of the guidelines (change in slope post-intervention -0.491; 95% CI -1.221, 0.239).
Conclusions: The release of the 2016 CDC prescribing guidelines is associated with decreasing incident opioid prescriptions and decreased treatment duration among patients with CLBP. Despite being one of the most common conditions for seeking medical care, most prescribed medications for CLBP are typically off-label. Policies which aim to increase use of non-opioid alternatives among this population may help improve long term patient outcomes as prescribing patterns continue to shift.
