Rodin Rebecca, Li Lihua, McKendrick Karen, Harrison Krista, Hunt Lauren J, Muench Ulrike, Smith Cardinale B, Aldridge Melissa D, Morrison R Sean
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
JAMA Netw Open. 2025 May 1;8(5):e259043. doi: 10.1001/jamanetworkopen.2025.9043.
In 2016, the Centers for Disease Control and Prevention (CDC) published guidelines cautioning against prescribing opioids for chronic noncancer pain. Little is known about unintended outcomes of this guideline on analgesic prescribing for older adults with cancer, who commonly require opioids as first-line pain treatment.
To determine whether the 2016 CDC guideline was associated with altered analgesic prescribing among older adults with cancer.
DESIGN, SETTING, AND PARTICIPANTS: Interrupted time series analysis of a longitudinal cohort using Medicare Current Beneficiary Survey (MCBS) dataset (2010-2020), a nationally representative longitudinal survey of Medicare beneficiaries linked to Medicare claims. MCBS participants older than 65 years who reported a non-skin cancer diagnosis were followed up for up to 4 years. Subgroup analysis conducted for those with poor prognosis cancer or a cancer-related pain encounter (advanced cancer/cancer pain). Data were analyzed from January 2023 to February 2025.
CDC Guideline for Prescribing Opioids for Chronic Pain publication in March 2016.
Quarterly prescribing rates of opioids (typical opioids, tramadol, and buprenorphine) and gabapentinoids (gabapentin and pregabalin). For each time series analysis outcome, a level change estimated immediate change and trend (ie, slope) change estimated ongoing change following the guideline.
The cohort included 11 903 older adults with cancer (mean [IQR] age, 79.4 [73-85] years, 6504 [54.6%] women), including 1283 with advanced cancer or cancer pain. Compared with preguideline trends, we observed the following changes after the guideline release: the slope of opioid prescribing decreased (typical opioids: -0.47; 95% CI, -0.63 to -0.30 percentage points [pp]/quarter; tramadol: -0.27; 95% CI, -0.36 to -0.17 pp/quarter; buprenorphine: -0.01; 95% CI, -0.02 to -0.01 pp/quarter), though tramadol prescribing rose by 11.5% overall; and gabapentinoid prescribing increased by 24.9% (slope change, -0.03; 95% CI, -0.09 to 0.02 pp/quarter).
In this cohort study of older adults with cancer, the 2016 CDC guideline was associated with a decline in opioid prescribing that was less pronounced for tramadol compared with typical opioids and was followed by a 25% increase in gabapentinoid prescribing. This may reflect a shift in cancer pain management from first-line opioids to tramadol, which is less safe, and gabapentinoids, which have been shown to be less effective for cancer pain treatment.
2016年，美国疾病控制与预防中心（CDC）发布指南，告诫不要为慢性非癌性疼痛开具阿片类药物处方。对于通常需要将阿片类药物作为一线疼痛治疗药物的老年癌症患者，该指南的意外后果鲜为人知。
确定2016年CDC指南是否与老年癌症患者镇痛药物处方的改变有关。
设计、设置和参与者：使用医疗保险当前受益人调查（MCBS）数据集（2010 - 2020年）对纵向队列进行中断时间序列分析，这是一项与医疗保险理赔相关的全国代表性医疗保险受益人的纵向调查。对报告患有非皮肤癌诊断的65岁以上MCBS参与者进行了长达4年的随访。对预后不良癌症患者或有癌症相关疼痛经历（晚期癌症/癌症疼痛）的患者进行亚组分析。数据于2023年1月至2025年2月进行分析。
2016年3月发布的CDC慢性疼痛阿片类药物处方指南。
阿片类药物（典型阿片类药物、曲马多和丁丙诺啡）和加巴喷丁类药物（加巴喷丁和普瑞巴林）的季度处方率。对于每个时间序列分析结果，水平变化估计即时变化，趋势（即斜率）变化估计指南发布后的持续变化。
该队列包括11903名老年癌症患者（平均[四分位间距]年龄为79.4[73 - 85]岁，6504名[54.6%]为女性），其中1283名患有晚期癌症或癌症疼痛。与指南发布前的趋势相比，指南发布后我们观察到以下变化：阿片类药物处方斜率下降（典型阿片类药物：-0.47；95%置信区间，-0.63至-0.30个百分点[pp]/季度；曲马多：-0.27；95%置信区间，-0.36至-0.17 pp/季度；丁丙诺啡：-0.01；95%置信区间，-0.02至-0.01 pp/季度），不过曲马多总体处方量上升了11.5%；加巴喷丁类药物处方量增加了24.9%（斜率变化，-0.03；95%置信区间，-0.09至0.02 pp/季度）。
在这项针对老年癌症患者的队列研究中，2016年CDC指南与阿片类药物处方量下降有关，与典型阿片类药物相比，曲马多的下降不太明显，随后加巴喷丁类药物处方量增加了25%。这可能反映了癌症疼痛管理从一线阿片类药物转向安全性较低的曲马多以及对癌症疼痛治疗效果较差的加巴喷丁类药物的转变。
