LAUSR

OBJECTIVE To identify changes in opioid prescribing across a diverse array of medical specialties following release of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. DESIGN Interrupted time-series analysis using a commercial prescribing database. SUBJECTS De-identified recipients of opioid prescriptions dispensed at U.S. retail pharmacies between 2015 to 2019. METHODS Opioid dispensing data were obtained from the IQVIA Longitudinal Prescription (LRx) database, representing over 800 million opioid prescriptions. Monthly dispensing rates, dosage in morphine milligram equivalents (MME), and mean prescription duration were calculated across 29 medical specialties. Changes in dispensing following release of the 2016 CDC Guideline were assessed using interrupted time-series analysis. RESULTS Declining trends in opioid dispensing accelerated in 24 of 29 specialty groups after the release of the CDC Guideline (p < 0.05 for 15 groups). Decreases were greatest among family medicine clinicians, where declines accelerated by 4.4 prescriptions per month per 100,000 persons (p = 0.005), and surgeons, where declines accelerated by 3.6 prescriptions per month per 100,000 (p = 0.003). CONCLUSIONS These results illustrate that clinicians likely to provide primary care exhibited the greatest decreases in opioid dispensing. However, specialties outside the scope of the CDC Guideline (e.g., surgery) also exhibited accelerated decreases in prescribing. These declines illustrate that specialties beyond primary care may have interest in evaluating opioid prescribing practices, supporting the importance of specialty-specific guidance that balances individualized risks and benefits of opioids and the role of non-opioid treatments.