Assessing the impact of a national clinical guideline for the management of chronic pain on opioid prescribing rates: a controlled interrupted time series analysis.

Hébert, Harry L.; Morales, Daniel R.; Torrance, Nicola; Smith, Blair H.; Colvin, Lesley A.

Abstract

Background: Opioids can be effective analgesics, but long-term use may be associated with harms. In 2013, the first national, comprehensive, evidence-based pain management guideline was published, from the Scottish Intercollegiate Guideline Network (SIGN 136: Management of Chronic Pain) with key recommendations on analgesic prescribing. This study aimed to examine the potential impact on national opioid prescribing rates in Scotland. Methods: Trends in national and regional community opioid prescribing data for Scotland were analysed from quarter one (Q1) 2005 to Q2 2020. Interrupted time series regression examined the association of SIGN 136 publication with prescribing rates for opioid-containing drugs. Gabapentinoid prescribing was used as a comparison drug. Results: After a positive prescribing trend pre-publication, the timing of SIGN 136 publication was associated with a negative change in the trend of opioid prescribing rates (−2.82 items per 1000 population per quarter [PTPPQ]; P < 0.01). By Q2 2020, the relative reduction in the opioid prescribing rate was −20.67% (95% CI: −23.61, −17.76). This persisted after correcting for gabapentinoid prescribing and was mainly driven by the reduction in weak opioids, whereas strong opioid prescribing rates continued to rise. Gabapentinoid prescribing showed a significant rise in level (8.00 items per 1000 population; P = 0.01) and trend (0.27 items PTPPQ; P = 0.01) following SIGN 136 publication. Conclusions: The publication of SIGN 136 was associated with a reduction in opioid prescribing rates. This suggests that changes in clinical policy through evidence-based national clinical guidelines may affect community opioid prescribing, though this may be partially replaced by gabapentinoids, and other factors may also contribute.

Citation

HÉBERT, H.L., MORALES, D.R., TORRANCE, N.A., SMITH, B.H. and COLVIN, L.A. 2022. Assessing the impact of a national clinical guideline for the management of chronic pain on opioid prescribing rates: a controlled interrupted time series analysis. Implementation science [online], 17(1), article number 77. Available from: https://doi.org/10.1186/s13012-022-01251-2

• Journal Article Type: Article
• Acceptance Date: Nov 9, 2022
• Online Publication Date: Nov 22, 2022
• Publication Date: Dec 31, 2022
• Deposit Date: Dec 1, 2022
• Publicly Available Date: Dec 1, 2022
• Journal: Implementation science
• Electronic ISSN: 1748-5908
• Publisher: Springer
• Peer Reviewed: Peer Reviewed
• Volume: 17
• Issue: 1
• Article Number: 77
• DOI: https://doi.org/10.1186/s13012-022-01251-2
• Keywords: Chronic pain; Clinical guideline; Interrupted time series analysis; Opioids; Prescribing rates
• Public URL: https://rgu-repository.worktribe.com/output/1818055
• Related Public URLs: https://rgu-repository.worktribe.com/output/1823620
• Additional Information: The preprint of this article was published on medRxiv: https://doi.org/10.1101/2021.02.19.21251770