Clinical guidelines may lead to better prescribing practices

Originally Published By 2 Minute Medicine®. Reused on MPR with permission.

1. Following clinical guidelines release, decreases were observed in the overall rate of opioid prescribing.

2. Guidelines may be associated with reduced high-dosage opioid prescriptions and the percentage of patients with overlapping benzodiazepine and opioid prescriptions.

Evidence Rating Level: 2 (Good)

Study Rundown: Opioid overuse and misuse remains a significant problem in North America. Although opioid prescribing in the United States has declined, with respect to the overall number of prescriptions written and the frequency of specific risky prescribing practices, one of the more significant reductions in opioid prescription occurred at the same time as the Centers for Disease Control and Prevention's (CDC) Guideline for Prescribing Opioids for Chronic Pain. The authors of this study aimed to test the hypothesis that these guidelines corresponded to a decline in specific opioid prescribing practices. One limitation of this study was that there was no control population within the study. Furthermore, the authors did not capture prescriptions dispensed directly or via mail order. Study strengths consisted of the large population data represented opioid prescribing statistics across the United States.

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Click to read the study in Annals of Internal Medicine

Relevant Reading: Reducing Opioid Prescribing Rates in Emergency Medicine

In-Depth [interrupted time series analysis]: The authors of this study conducted an interrupted time series analysis of monthly prescribing measures, using data collected from the IQVIA transactional data warehouse and the Real-World Data Longitudinal Prescriptions population-level estimates. The study setting ranged from 2012 to 2017 and assessed data from the United States. The main outcomes of interest included opioid dosage, days supplied, and overall prescribing rates, among others. In total, an average of 19.1 million opioid prescriptions were written each month. Following the release of the CDC guidelines, the authors observed a change in the overall opioid prescription rate (p < 0.001) decrease faster (March 2016) than previously. Similar trends were observed with high-dosage prescribing rate and percentage of patients with overlapping benzodiazepines.

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