Abstract
IMPORTANCE: 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. OBJECTIVE: 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. EXPOSURE: CDC Guideline for Prescribing Opioids for Chronic Pain publication in March 2016. MAIN OUTCOMES AND MEASURES: 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. RESULTS: 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). CONCLUSIONS AND RELEVANCE: 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.