Opioid Prescribing in the United States Before and After the Centers for Disease Control and Prevention's 2016 Opioid Guideline

Ann Intern Med. 2018 Sep 18;169(6):367-375. doi: 10.7326/M18-1243. Epub 2018 Aug 28.


Background: In response to adverse outcomes from prescription opioids, the Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain in March 2016.

Objective: To test the hypothesis that the CDC guideline release corresponded to declines in specific opioid prescribing practices.

Design: Interrupted time series analysis of monthly prescribing measures from the IQVIA transactional data warehouse and Real-World Data Longitudinal Prescriptions population-level estimates based on retail pharmacy data. Population size was determined by U.S. Census monthly estimates.

Setting: United States, 2012 to 2017.

Patients: Persons prescribed opioid analgesics.

Measurements: Outcomes included opioid dosage, days supplied, overlapping benzodiazepine prescriptions, and the overall rate of prescribing.

Results: The rate of high-dosage prescriptions (≥90 morphine equivalent milligrams per day) was 683 per 100 000 persons in January 2012 and declined by 3.56 (95% CI, -3.79 to -3.32) per month before March 2016 and by 8.00 (CI, -8.69 to -7.31) afterward. Likewise, the percentage of patients with overlapping opioid and benzodiazepine prescriptions was 21.04% in January 2012 and declined by 0.02% (CI, -0.04% to -0.01%) per month before the CDC guideline release and by 0.08% (CI, -0.08% to -0.07%) per month afterward. The overall opioid prescribing rate was 6577 per 100 000 persons in January 2012 and declined by 23.48 (CI, -26.18 to -20.78) each month before the guideline release and by 56.74 (CI, -65.96 to -47.53) per month afterward.

Limitation: No control population; inability to determine the appropriateness of opioid prescribing.

Conclusion: Several opioid prescribing practices were decreasing before the CDC guideline, but the time of its release was associated with a greater decline. Guidelines may be effective in changing prescribing practices.

Primary funding source: CDC.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Analgesics, Opioid / therapeutic use*
  • Benzodiazepines / therapeutic use
  • Centers for Disease Control and Prevention, U.S.
  • Chronic Pain / drug therapy*
  • Drug Prescriptions / statistics & numerical data*
  • Guideline Adherence*
  • Humans
  • Interrupted Time Series Analysis
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians'*
  • United States


  • Analgesics, Opioid
  • Benzodiazepines