Association of the 2016 US Centers for Disease Control and Prevention Opioid Prescribing Guideline with Changes in Opioid Dispensing after Surgery

Abstract

Importance: While the 2016 US Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids for chronic pain was not intended to address postoperative pain management, observers have noted the potential for the guideline to have affected postoperative opioid prescribing. Objective: To assess changes in postoperative opioid dispensing after vs before the CDC guideline release in March 2016. Design, Setting, and Participants: This cross-sectional study included 361556 opioid-naive patients who received 1 of 8 common surgical procedures between March 16, 2014, and March 15, 2018. Data were retrieved from a private insurance database, and a retrospective interrupted time series analysis was conducted. Data analysis was conducted from March 2014 to April 2018. Exposure: Outcomes were measured before and after release of the 2016 CDC guideline. Main Outcomes and Measures: The primary outcome was the total amount of opioid dispensed in the first prescription filled within 7 days following surgery in morphine milligram equivalents (MMEs); secondary outcomes included the total amount of opioids prescribed and the incidence of any opioid refilled within 30 days after surgery. To characterize absolute opioid dispensing levels, the amount dispensed in initial prescriptions was compared with available procedure-specific recommendations. Results: The sample included 361556 opioid-naive patients undergoing 8 general and orthopedic surgical procedures; 164009 (45.4%) were male patients, and the median (interquartile range) age of the sample was 58 (45 to 69) years. The total amount of opioids dispensed in the first prescription after surgery decreased in the 2 years following the CDC guideline release, compared with an increasing trend in the 2 years prior (prerelease trend: 1.43 MME/month; 95% CI, 0.62 to 2.24 MME/month; P =.001; postrelease trend: -2.18 MME/month; 95% CI, -3.01 to -1.35 MME/month; P