Dementia and the opioid epidemic: The impact of the 2016 CDC guidelines on disparities in pain management
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PROJECT SUMMARY/ABSTRACT The research proposed in this application aims to study the impact of the publication of the 2016 Centers for Disease Control and Prevention (CDC) analgesic prescribing guidelines on disparities in opioid utilization among older adults who have opioid-responsive pain. These CDC guidelines were published at that time to help curb the rising number of overdose-related deaths related to prescription and illicit opioids, which have caused the death of over half a million people in the United States since 1999. The guidelines recommended cautious use or avoidance of opioid medications in persons with chronic, non-cancer pain and those not near the end of life. However, preliminary evidence suggests that these guidelines may have had an unintended effect of limiting access to legitimate and medically necessary opioids in people with serious illnesses. This is of particular concern among vulnerable subgroups of older adults known to be risk of pain undertreatment. Our analyses will focus on three highly vulnerable subgroups of older adults who have been found to be at increased risk of pain undertreatment – persons with Alzheimer’s and related dementias (PW-ADRD), those identifying as racial/ethnic minoritized individuals, and those experiencing socioeconomic deprivation. For each of these three subgroups, we will employ two models of opioid-responsive pain conditions – chronic cancer pain and acute pain from orthopedic trauma – for which the CDC guidelines were not intended to apply and for which opioids remain a mainstay of therapy for pain control. These two conditions are common in older adults and are often associated with moderate to severe pain. For each of the three subgroups of older adults, we will utilize the Medicare Current Beneficiary Survey (MCBS) to obtain sociodemographic and clinical information on opioid prescribing from 2010 to 2020. MCBS is a longitudinal survey of a nationally representative sample of the Medicare population, with data collected three times per year over a 4-year period and approximately 15,000 respondents each year, and includes linked fee-for-service Medicare Part A and B claims, participant- reported prescribed medicines, and records of Medicare Part D pharmacy events. We will use a difference-in- differences design to compare the unintended impact of the 2016 CDC guidelines on opioid utilization from 2010-2020 in the following groups of older adults who have either cancer or hip or pelvic fracture: PW-ADRD compared to persons without ADRD (Aims 1-3), those with self-reported income at or below the federal poverty line, compared to individuals with higher income (Aim 2), and racial/ethnic minoritized older adults compared to white older adults (Aim 3).
