Changes in Opioid Prescriptions and Potential Misuse and Substance Use Disorders Among Childhood Cancer Survivors Following the 2016 Opioid Prescribing Guideline
Authors: Hu Xin , Brock Katharine E. , Effinger Karen E. , Zhang Bo , Graetz Ilana , Lipscomb Joseph , Ji Xu 
Published: September 2022

Importance

The Centers for Disease Control and Prevention (CDC) released an opioid-prescribing guideline in March 2016. Little is known about the guideline’s potential effects on childhood cancer survivors, a population at high risk for pain.

Objective

To examine changes in opioid prescriptions and potential misuse/substance use disorders (SUD) among childhood cancer survivors and peers without cancer following the guideline release.

Design, Setting, and Participants

In this cohort study using the MarketScan Commercial Claims and Encounters Database, 8969 survivors who completed treatment for hematologic, central nervous system, bone, or gonadal cancers (aged ≤21 years at diagnosis) from 2009 to 2018 and 44 845 age-matched, sex-matched, and region-matched individuals without cancer were identified. With data aggregated based on the quarter-year of survivors’ treatment completion, interrupted time series analyses were conducted in this cohort study to estimate the immediate (level) change and change in time trend (trend change) for each outcome after the guideline release, accounting for autocorrelation. Data were analyzed from September 2021 to April 2022.

Exposures

Release of the CDC opioid-prescribing guideline.

Main Outcomes and Measures

Outcomes included any opioid prescription and any indicator for potential misuse/SUD within 1 year following completion of treatment.

Results

This study included 8969 childhood cancer survivors (mean [SD] age, 13.7 [6.2] years old; 3814 [42.5%] female patients) and 44 845 peers without cancer (mean [SD] age, 13.7 [6.2] years old; 19 070 [42.5%] female patients). Before the guideline release, the opioid prescription rate (21.1% vs 7.2%) and rate of potential misuse/SUD (5.6% vs 1.9%) were higher among survivors than peers without cancer. After the guideline release, the trend in opioid prescription rate declined among survivors (trend change, −1.1 percentage points [ppt]; P &amp;lt; .001; 95% CI, −1.5 to −0.7). Survivors also experienced an immediate level decrease (−2.1 ppt; P = .04; 95% CI, −4.2 to −0.1) and a decreasing trend (trend change, −0.4 ppt; P = .009; 95% CI, −0.6 to −0.1) in rate of potential misuse/SUD. Peers without cancer experienced decreasing trends in opioid prescription rate (trend change, −0.3 ppt; P &amp;lt; .001; 95% CI, −0.5 to −0.1) and rate of potential misuse/SUD (trend change, −0.1 ppt; P = .03; 95% CI, −0.1 to −0.01). By 2 years after the guideline release, relative reductions in opioid prescription rate and rate of potential misuse/SUD among survivors were 36.7% and 65.4%, respectively, with peers without cancer experiencing smaller reductions (15.9% and 29.9%).

Conclusions and Relevance

In this cohort study, the opioid prescription rate and rate of potential misuse/SUD 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.