Impact of opioid prescribing standards and guidelines on drug use among patients with long-term opioid use
| Analysis | No. of patients | Measures in prepolicy period* | Impact on outcome level† | Impact on outcome trend† | ||
|---|---|---|---|---|---|---|
| Historical control cohort | Policy cohort | Historical control cohort | Policy cohort | |||
| Monthly MME, mean ± SD | Adjusted difference (95% CI)‡ | Adjusted difference (95% CI)‡ | ||||
| Opioid analgesic use | 68 429 | 68 113 | 1770 ± 4200 | 1625 ± 3860 | −57 (−74 to −39) | −6.8 (−9.9 to −3.8) |
| Discontinuation | Monthly discontinuation, % | Adjusted OR (95% CI)‡ | Adjusted OR (95% CI)‡ | |||
| Discontinuation of opioid use§ | 66 203 | 65 791 | 2.5 | 2.6 | 1.24 (1.16 to 1.32) | 1.00 (0.98 to 1.01) |
| Discontinuation among high-dose opioid users¶ | 13 922 | 12 409 | 0.6 | 0.6 | 1.21 (0.91 to 1.59) | 0.98 (0.94 to 1.03) |
| Discontinuation of concurrent opioid and sedative/hypnotic use** | 28 483 | 26 506 | 9.2 | 9.4 | 1.37 (1.27 to 1.49) | 0.99 (0.97 to 1.00) |
| Switching | Monthly switching, % | Adjusted OR (95% CI)‡ | Adjusted OR (95% CI)‡ | |||
| Switching from high-dose to lower-dose opioid¶ | 13 922 | 12 409 | 2.5 | 2.6 | 1.88 (1.63 to 2.17) | 0.99 (0.97 to 1.01) |
| Initiation | Monthly initiation, % | Adjusted OR (95% CI)‡ | Adjusted OR (95% CI)‡ | |||
| Initiation of concurrent opioid and sedative/hypnotic use** | 54 934 | 56 441 | 2.1 | 2.0 | 1.10 (1.02 to 1.18) | 0.98 (0.97 to 0.99) |
Note: CI = confidence interval, MME = milligrams of morphine equivalents, OR = odds ratio, SD = standard deviation.
↵* Calculated based on all monthly observations during the 12-month prepolicy period for the policy cohort and corresponding period for the historical control cohort.
↵† “Impact on outcome level” measures a sudden change following implementation of a policy, whereas “impact on outcome trend” measures gradual change occurring each month following implementation of a policy.
↵‡ Adjusted for patient-level covariates, including demographic variables, medical history and prescription drug use.
↵§ Analysis of discontinuation of opioids included only patients who had a prescription with sufficient days’ supply to end in a given month.
↵¶ Analyses of discontinuation of high-dose opioids and switching from high-dose to lower-dose opioids included patients who had received a high-dose prescription (with a daily dosage > 90 mg of morphine equivalents) ending in a given month.
↵** Concurrent use was defined as overlapping supply according to the date and days’ supply dispensed. Analysis of discontinuation of concurrent use of opioids and sedatives/hypnotics included patients with concurrent use and an opioid or sedative/hypnotic prescription ending in a given month; analysis of initiation of concurrent use of these medications included only patients without concurrent use in the 180 days before the current month.