Little Change Seen in Rx of Opioids for Those at Risk for Misuse

WEDNESDAY, Dec. 16, 2020 — Schedule II opioids continue to be prescribed to high-risk patients 18 months after publication of the U.S. Centers for Disease Control and Prevention guideline, according to a study published online Dec. 2 in JAMA Network Open.

Jeffrey F. Scherrer, Ph.D., from the Saint Louis University School of Medicine, and colleagues compared the odds of new Schedule II opioid (codeine, hydrocodone, oxycodone) prescriptions versus Schedule IV opioid (tramadol) prescriptions in the 18-month periods before and after the CDC guidelines were released on March 15, 2016. The analysis included 279,435 U.S. adults identified through the Optum deidentified Integrated Claims-Clinical data set.

The researchers found that the prevalence of new prescriptions for each drug before and after guideline publication was 7.1 versus 7.0 percent for codeine, 47.4 versus 45.6 percent for hydrocodone, 22.4 versus 24 percent for oxycodone, and 23 versus 23.4 percent for tramadol. After guideline publication, the odds of being prescribed hydrocodone or oxycodone versus tramadol significantly decreased (odds ratios, 0.95 and 0.86, respectively). In patients with and without benzodiazepine comedication or psychiatric disorders, the odds of being prescribed a Schedule II opioid versus tramadol after versus before guideline publication were similar.

“This study’s findings suggest that, among patients at risk for opioid misuse, the odds of receiving a Schedule II opioid for noncancer pain versus tramadol in the 18-month periods before and after guideline publication were similar to the odds for those not at risk,” the authors write.

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