Opioid Prescribing Often Fails to Align with Guidelines, Study Finds

Potential discrepancies between clinical recommendations and actual opioid prescribing present opportunities for improving pain management and patient safety, advises a new analysis of 2017 prescribing for millions of US patients published online in JAMA Network Open. 

“In our analysis, we linked opioid prescriptions to 13% to 16% of nonsurgical acute pain visits, 30% to 50% of patients with chronic pain indications, 55% to 66% of surgical procedures, 43% to 45% of patients with sickle cell disease, and 32% to 57% of patients with cancer, with rates, days’ supply, and daily dosage varying widely across indications,” researchers wrote. “For many indications, opioid prescribing rates, days’ supply, and dosage did not align with evidence-based guidelines and practice-informed recommendations.” 

The study examined 2017 US administrative claims data for more than 18 million patients with private insurance and 11.4 million patients with Medicaid. Researchers looked at opioid prescribing rates, days’ supply per prescription, and daily dosage across 41 different clinical indications associated with pain. 

Overall, the study showed a broad variation in opioid prescribing patterns across clinical indications and by insurance type.

Although published guidelines recommend nonopioid treatment for fibromyalgia and chronic back pain, researchers found patients with fibromyalgia not on long-term opioid therapy were typically prescribed a month-or-longer supply of opioids. In addition, 28.3% of patients with private insurance and 44% with Medicaid coverage were started on opioids for chronic radicular back pain. 

Opioids were also prescribed for other indications for which guidelines recommend nonopioid treatment, such as acute back pain, musculoskeletal strains or sprains, and dental pain. 

“This comprehensive analysis of opioid prescribing across a broad variety of indications suggested that prescribing patterns for some indications were incongruent with existing evidence-based clinical guidelines,” researchers wrote. “These results may reflect low clinician awareness of applicable guidelines or reluctance to adhere to guidance.” 

—Jolynn Tumolo

Reference:

Mikosz CA, Zhang K, Haegerich T, et al. Indication-Specific Opioid Prescribing for US Patients With Medicaid or Private Insurance, 2017. JAMA Netw Open. 2020;3(5):e204514. Published 2020 May 1. doi:10.1001/jamanetworkopen.2020.4514