Increased opioid prescribing for pain management has brought surges of opioid misuse and overdose. Prescribing guidelines for chronic non-cancer (CNC) pain intended to limit opioid volume and dosage and mitigate repercussions of over-prescribing.
This systematic review aims to summarize the impact of prescribing guidelines on the prevalence, incidence, and dosage of opioid prescribing across multiple jurisdictions.
We systematically searched PubMed/MEDLINE, Scopus, Web of Science, and PsycInfo for literature estimating the effects of opioid prescribing guidelines on adult populations irrespective of study design, geography, or comparator. Our primary outcomes were opioid use prevalence and incidence, and dosage of opioids dispensed. We will perform two-step meta-analyses to calculate study-level effect estimates using interrupted time-series analyses and the pooled effect of guidelines on prescribing outcomes.
After screening, we included 42 of the 9,868 records identified in our search. Retained articles covered four patient categories: CNC, acute, cancer, and palliative pain. Among most studies included, prescribing guidelines decreased opioid use dosage and prevalence among people with CNC pain. Prevalence of opioid use also declined among guideline-exempt populations – those with cancer-related or acute pain.
While studies demonstrated decreased post-guideline prescription opioid use for CNC pain, the population-level effects of opioid prescribing guidelines remain unclear. Opioid prescribing reductions among patients with cancer-related or acute pain suggest unintended consequences of guideline implementation. Quantification of such spillover effects through our meta-analyses will inform the utility and appropriate use of prescribing guidelines across healthcare settings.