Declines in opioid prescriptions outpace increases in nonopioids for cancer, noncancer pain
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Clinicians in the United States prescribed fewer opioid medications for cancer pain and chronic noncancer pain between 2012 and 2019, according to a study published in PLOS ONE.
Authors of the study included Sachini Bandara, PhD, assistant professor in the department of mental health at Johns Hopkins Bloomberg School of Public Health; Emma E. McGinty, PhD, professor at Weill Cornell Medical College; and Mark Bicket, MD, assistant professor in the department of anesthesiology at University of Michigan School of Medicine.
In light of CDC’s 2016 practice guideline on prescribing opioids for chronic pain, professional organizations, insurance payers and clinicians have curtailed their use of opioids in favor of other, often multidisciplinary treatments for management of pain, including pain associated with cancer.
“There has been a body of literature showing that opioid prescribing among the general population has decreased in the United States, and we were very interested in the kinds of conversations that were happening, both among advocates and patient advocate groups, as well as providers who treat chronic pain,” Bandara said in an interview with Healio. “We wanted to know whether this reduction in opioid prescribing, and also efforts to curb high-risk opioid prescribing, might unintentionally be affecting the populations who might be using opioids for pain management.”
Bandara and colleagues found that between 2012 and 2019, the percentage of people who received any opioid prescription decreased from 49.7% to 30.5% for patients with chronic noncancer pain and from 86% to 78.7% for those with cancer. The rates of nonopioid medication prescription remained stable for those with noncancer pain, whereas prescriptions for nonopioid pain medication increased for patients with cancer, from 74.4% to 78.8%.
Bandara spoke with Healio about the emphasis on curbing opioid abuse and the ongoing need to provide adequate pain relief to those with cancer and other chronic conditions.
Healio: How did you conduct this study?
Bandara: We used the MarketScan database, which includes data from about 100 insurance companies in the United States. On any given year, it ranges from looking at about 26 million to 50 million enrollers. Within this data set, we identified a population of people in each year who had a diagnosis of either chronic noncancer pain, which we defined as low back pain, neuropathic pain, serious headaches, or arthritis. Then we identified a population of people who were diagnosed with cancer. We looked at opioid prescribing rates among those populations each year.
Healio: Do you think the decreases you saw in opioid prescription are related to the increased concern about opioid dependency and abuse?
Bandara: What I really liked about this study was that we looked not only at opioid prescribing but also nonopioid prescriptions for management of cancer and noncancer pain. We wanted to see whether the opioid prescription reduction was in any way offset by an increase in nonopioid pain management medications and techniques. In the cancer population, we found that nonopioid prescribing went up a bit, although not as much as opioid prescribing decreased.
To me, that begs the question: How can we understand how pain among these populations is being managed? Is it being managed effectively? We know that high doses of opioids for long periods are associated with increased overdose risk and other adverse outcomes. At the same time, we don’t want to compensate for that to the point that we’re not managing these patients’ pain appropriately. This type of research opens up that question — are these patients being managed properly, is their pain under control? Or have we swung too far?
Healio: What did your sub-analysis of individual patients find?
Bandara: Our sub-analysis looked at individuals who had at least 2 years of data in the sample. We compared year 1 to year 2 to determine whether, if they had a reduction in opioids at the individual level, they had an increase in nonopioid pain prescriptions. For the most part, we found that of people who experienced a reduction in their opioid prescriptions, about 40% didn’t have that substituted by an increase in nonopioid pain treatment. So, I think this points to the fact that we need to do some work to understand pain management. We are a team of policy researchers, so we really want to understand the effects of different prescribing policies on chronic noncancer pain.
Healio: What is next in your research on this?
Bandara: I think the next step for us is to dig in and understand the impact of these policies on prescribing practices. My co-author on this project, Dr. McGinty, has been doing some work on this, focusing mostly on patients with chronic noncancer pain. I also think it would be wonderful to be able to contextualize our findings with some qualitative work.
For more information :
Sachini Bandara, PhD can be reached at 624 N. Broadway, Hampton House 843, Baltimore, MD 21205; email: sbandar2@jhu.edu.
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