In a study reported in JAMA Oncology, Hu et al found decreases in the rates of opiate prescription and potential misuse/substance use disorders among survivors of childhood cancer following the March 2016 release of the Centers for Disease Control and Prevention (CDC) opioid-prescribing guideline. Relative decreases in survivors were greater than those in matched controls without a cancer history.
Study Details
The study used data from the MarketScan Commercial Claims and Encounters Database on 8,969 survivors aged ≤ 21 at diagnosis who completed treatment of hematologic, central nervous system, bone, or gonadal cancers from 2009 to 2018 and 44,845 age-, sex-, and region-matched individuals without cancer. Outcomes included any opioid prescription and any indicator for potential misuse/substance use disorder within 1 year of completion of treatment. Changes in each outcome at the end of the first 2 years following the guideline release were calculated. Immediate changes were those occurring in the first quarter year following the guideline release. Trends indicated changes over time up to 2 years after the guideline release.
Key Findings
Before the guideline release, opioid prescription rates were 21.1% among survivors and 5.6% among controls, and the rates of potential misuse/substance use disorder were 7.2% and 1.9%.
After the guideline release, survivors exhibited a significant declining trend in opioid prescription rate (trend change = −1.1 percentage points, 95% confidence interval [CI] = −1.5 to −0.7 percentage points, P < .001) and significant immediate decrease (−2.1 percentage points, 95% CI = −4.2 to −0.1 percentage points, P = .04) and decreasing trend (trend change = −0.4 percentage points, 95% CI = −0.6 to −0.1 percentage points, P = .009) in the rate of potential misuse/substance use disorder.
After the guideline release, controls exhibited significant decreasing trends in opioid prescription rate (trend change = −0.3 percentage points, 95% CI = −0.5 to −0.1 percentage points, P < .001) and the rate of potential misuse/substance use disorder (trend change = −0.1 percentage points, 95% CI = −0.1 to −0.01 percentage points, P = .03).
About 2 years after the guideline release, relative reductions among survivors vs controls were 36.7% vs 15.9% in the opioid prescription rate and 65.4% vs 29.9% in the rate of potential misuse/substance use disorder.
The investigators concluded: “In this cohort study, the opioid prescription rate and rate of potential misuse/substance use disorder declined among both survivors and peers without cancer following the CDC guideline release, with survivors experiencing greater reductions. More research is needed to understand the guideline’s potential effects on access to opioids required for pain control among childhood cancer survivors.”
Xu Ji, PhD, of the Department of Pediatrics, Emory University School of Medicine, is the corresponding author of the JAMA Oncology article.
Disclosure: The study was supported by a Junior Faculty Focused Award of the Pediatric Research Alliance Pilot Grant Programs and an Aflac Pilot Grant at Children’s Healthcare of Atlanta. For full disclosures of the study authors, visit jamanetwork.com.
