{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:04:04Z","timestamp":1792112644018,"version":"4.4.0"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2022,11,1]]},"abstract":"Importance<\/jats:title>The Centers for Disease Control and Prevention (CDC) released an opioid-prescribing guideline in March 2016. Little is known about the guideline\u2019s potential effects on childhood cancer survivors, a population at high risk for pain.<\/jats:p><\/jats:sec>Objective<\/jats:title>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.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>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 \u226421 years at diagnosis) from 2009 to 2018 and 44\u202f845 age-matched, sex-matched, and region-matched individuals without cancer were identified. With data aggregated based on the quarter-year of survivors\u2019 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.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Release of the CDC opioid-prescribing guideline.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Outcomes included any opioid prescription and any indicator for potential misuse\/SUD within 1 year following completion of treatment.<\/jats:p><\/jats:sec>Results<\/jats:title>This study included 8969 childhood cancer survivors (mean [SD] age, 13.7 [6.2] years old; 3814 [42.5%] female patients) and 44\u202f845 peers without cancer (mean [SD] age, 13.7 [6.2] years old; 19\u202f070 [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, \u22121.1 percentage points [ppt]; P<\/jats:italic>\u2009&amp;lt;\u2009.001; 95% CI, \u22121.5 to \u22120.7). Survivors also experienced an immediate level decrease (\u22122.1 ppt; P<\/jats:italic>\u2009=\u2009.04; 95% CI, \u22124.2 to \u22120.1) and a decreasing trend (trend change, \u22120.4 ppt; P<\/jats:italic>\u2009=\u2009.009; 95% CI, \u22120.6 to \u22120.1) in rate of potential misuse\/SUD. Peers without cancer experienced decreasing trends in opioid prescription rate (trend change, \u22120.3 ppt; P<\/jats:italic>\u2009&amp;lt;\u2009.001; 95% CI, \u22120.5 to \u22120.1) and rate of potential misuse\/SUD (trend change, \u22120.1 ppt; P<\/jats:italic>\u2009=\u2009.03; 95% CI, \u22120.1 to \u22120.01). 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%).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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\u2019s potential effects on access to opioids required for pain control among childhood cancer survivors.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoncol.2022.3744","type":"journal-article","created":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T15:32:17Z","timestamp":1662651137000},"page":"1658","source":"Crossref","is-referenced-by-count":11,"title":["Changes in Opioid Prescriptions and Potential Misuse and Substance Use Disorders Among Childhood Cancer Survivors Following the 2016 Opioid Prescribing Guideline"],"prefix":"10.1001","volume":"8","author":[{"given":"Xin","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine E.","family":"Brock","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"},{"name":"Aflac Cancer & Blood Disorders Center, Children\u2019s Healthcare of Atlanta, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen E.","family":"Effinger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"},{"name":"Aflac Cancer & Blood Disorders Center, Children\u2019s Healthcare of Atlanta, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology and Institutional Centers for Clinical and Translational Research Biostatistics and Research Design Center, Boston Children\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilana","family":"Graetz","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Lipscomb","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"},{"name":"Aflac Cancer & Blood Disorders Center, Children\u2019s Healthcare of Atlanta, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"cbr220020r1","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1038\/nrc3634","article-title":"Survivors of childhood and adolescent cancer: life-long risks and responsibilities.","volume":"14","author":"Robison","year":"2014","journal-title":"Nat Rev Cancer"},{"issue":"12","key":"cbr220020r2","doi-asserted-by":"publisher","first-page":"2915","DOI":"10.1002\/cncr.32853","article-title":"Longitudinal pain and pain interference in long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.","volume":"126","author":"Karlson","year":"2020","journal-title":"Cancer"},{"issue":"10","key":"cbr220020r5","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1001\/jamaoncol.2018.1574","article-title":"Bridging the critical divide in pain management guidelines from the CDC, NCCN, and ASCO for cancer survivors.","volume":"4","author":"Meghani","year":"2018","journal-title":"JAMA Oncol"},{"key":"cbr220020r6","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.jpeds.2017.11.063","article-title":"Early post-therapy prescription drug usage among childhood and adolescent cancer survivors.","volume":"195","author":"Smitherman","year":"2018","journal-title":"J Pediatr"},{"issue":"6","key":"cbr220020r7","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1093\/jnci\/djac049","article-title":"Early posttherapy opioid prescription, potential misuse, and substance use disorder among pediatric cancer survivors.","volume":"114","author":"Ji","year":"2022","journal-title":"J Natl Cancer Inst"},{"issue":"8","key":"cbr220020r10","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.2337\/dc16-2133","article-title":"An interrupted time series analysis to determine the effect of an electronic health record\u2013based intervention on appropriate screening for type 2 diabetes in urban primary care clinics in New York City.","volume":"40","author":"Albu","year":"2017","journal-title":"Diabetes Care"},{"issue":"2","key":"cbr220020r11","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.jclinepi.2008.08.007","article-title":"Methods for estimating confidence intervals in interrupted time series analyses of health interventions.","volume":"62","author":"Zhang","year":"2009","journal-title":"J Clin Epidemiol"},{"issue":"3","key":"cbr220020r12","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1093\/jnci\/djaa110","article-title":"Temporal trends in opioid prescribing patterns among oncologists in the Medicare population.","volume":"113","author":"Jairam","year":"2021","journal-title":"J Natl Cancer Inst"},{"key":"cbr220020r13","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.drugalcdep.2018.09.022","article-title":"Laws limiting the prescribing or dispensing of opioids for acute pain in the United States: a national systematic legal review.","volume":"194","author":"Davis","year":"2019","journal-title":"Drug Alcohol Depend"},{"issue":"4","key":"cbr220020r15","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.v67.4","article-title":"Children\u2019s cancer pain in a world of the opioid epidemic: challenges and opportunities.","volume":"67","author":"Fortier","year":"2020","journal-title":"Pediatr Blood Cancer"},{"key":"cbr220020r4","volume-title":"CDC Guideline for Prescribing Opioids for Chronic Pain\u2014United States, 2016","author":"Dowell","year":"2016"},{"key":"cbr220020r3","unstructured":"Substance Abuse and Mental Health Services Administration. A treatment improvement protocol: managing chronic pain in adults with or in recovery from substance use disorders. 2011. Accessed June 1, 2021. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK92048\/pdf\/Bookshelf_NBK92048.pdf"},{"key":"cbr220020r8","unstructured":"Centers for Disease Control and Prevention. Data resources: analyzing opioid prescription data and oral morphine milligram equivalents (MME). Accessed June 1, 2021. https:\/\/www.cdc.gov\/opioids\/data-resources\/index.html"},{"key":"cbr220020r9","unstructured":"Centers for Medicare & Medicaid Services. Other chronic health, mental health, and potentially disabling conditions. Chronic Conditions Data Warehouse. Accessed July 1, 2021. https:\/\/www2.ccwdata.org\/web\/guest\/condition-categories?"},{"key":"cbr220020r14","unstructured":"Cancer Action Network, Public Opinion Strategies, Patient Quality of Life Coalition. Key findings summary: Opioid Access Research Project. Accessed July 29, 2022. https:\/\/www.fightcancer.org\/sites\/default\/files\/ACS%20CAN%20PQLC%20Opioid%20Research%20Project%20Key%20Findings%20Summary%20Memo%20FINAL.pdf"}],"container-title":["JAMA Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaoncology\/articlepdf\/2796101\/jamaoncology_hu_2022_br_220020_1668658039.19046.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T16:05:25Z","timestamp":1668701125000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaoncology\/fullarticle\/2796101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,1]]},"references-count":15,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2022,11,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoncol.2022.3744","relation":{},"ISSN":["2374-2437"],"issn-type":[{"value":"2374-2437","type":"print"}],"subject":[],"published":{"date-parts":[[2022,11,1]]}}}