Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
Changes in opioid prescribing and high-risk co-prescribing after implementation of the 2016 CDC opioid guideline among older adults with and without cancer.
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Olateju Olajumoke A, Byun Joo-Young, Okeke Chijioke M, Shen Chan, Thornton J Douglas
Аннотация
PURPOSE: To evaluate changes in opioid prescribing and high-risk opioid co-prescribing before and after the 2016 CDC Guideline among Medicare beneficiaries with and without cancer.
METHODS: Using SEER-Medicare data (2014-2017), we identified beneficiaries diagnosed with breast, colon, or lung cancer and a comparison cohort without cancer. All patients were continuously enrolled in Medicare Parts A, B, and D and not enrolled in Medicare Advantage. The pre-policy period was January 2014-November 2015 and the post-policy period was April 2016-September 2017. Outcomes assessed within 3 months of diagnosis or index claim included monthly opioid prescribing rates, monthly days of opioid supply, daily morphine milligram equivalents (MME), and high-risk co-prescribing with benzodiazepines, antidepressants, or non-benzodiazepine sedatives. Difference-in-difference models compared changes between groups before and after guideline implementation, adjusting for baseline characteristics.
RESULTS: The study included 42,931 cancer and 108,218 patients without cancer. After guideline implementation, opioid prescribing declined in both groups but more substantially among patients without cancer, while changes among patients with cancer were minimal. Difference-in-difference estimates indicated smaller reductions among cancer versus patients without cancer in monthly opioid prescribing (- 0.14; 95% CI, - 0.17 to - 0.11; p < 0.0001) and days of supply (- 3.07; 95% CI, - 3.68 to - 2.45; p < 0.0001). Changes in daily MME did not differ significantly (16.73; 95% CI, - 43.36 to 76.82; p = 0.5853). High-risk co-prescribing declined overall but decreased less among patients with cancer for opioid-benzodiazepine, opioid-antidepressant, and opioid-non-benzodiazepine sedative combinations (all p < 0.0001).
CONCLUSION: Following the 2016 CDC guideline, reductions in opioid prescribing and high-risk co-prescribing were greater among patients without cancer, with minimal change observed among patients with cancer.
METHODS: Using SEER-Medicare data (2014-2017), we identified beneficiaries diagnosed with breast, colon, or lung cancer and a comparison cohort without cancer. All patients were continuously enrolled in Medicare Parts A, B, and D and not enrolled in Medicare Advantage. The pre-policy period was January 2014-November 2015 and the post-policy period was April 2016-September 2017. Outcomes assessed within 3 months of diagnosis or index claim included monthly opioid prescribing rates, monthly days of opioid supply, daily morphine milligram equivalents (MME), and high-risk co-prescribing with benzodiazepines, antidepressants, or non-benzodiazepine sedatives. Difference-in-difference models compared changes between groups before and after guideline implementation, adjusting for baseline characteristics.
RESULTS: The study included 42,931 cancer and 108,218 patients without cancer. After guideline implementation, opioid prescribing declined in both groups but more substantially among patients without cancer, while changes among patients with cancer were minimal. Difference-in-difference estimates indicated smaller reductions among cancer versus patients without cancer in monthly opioid prescribing (- 0.14; 95% CI, - 0.17 to - 0.11; p < 0.0001) and days of supply (- 3.07; 95% CI, - 3.68 to - 2.45; p < 0.0001). Changes in daily MME did not differ significantly (16.73; 95% CI, - 43.36 to 76.82; p = 0.5853). High-risk co-prescribing declined overall but decreased less among patients with cancer for opioid-benzodiazepine, opioid-antidepressant, and opioid-non-benzodiazepine sedative combinations (all p < 0.0001).
CONCLUSION: Following the 2016 CDC guideline, reductions in opioid prescribing and high-risk co-prescribing were greater among patients without cancer, with minimal change observed among patients with cancer.