Journal of general internal medicine
October 20, 2026 · via Europe PMC
Opioid and Gabapentinoid Prescribing in Older Adults with Dementia Before and After the 2016 CDC Opioid Prescribing Guideline.
Veschio T, McKendrick K, Li L, +6 more, Rodin R.
AI summary — for doctors, generated from the abstract only
The 2016 CDC guideline was not linked to an overall drop in opioid prescribing in older adults with dementia, but was linked to less tramadol use while gabapentinoid use kept rising.
What was studied
Interrupted time series of 3246 community-dwelling Medicare Current Beneficiary Survey participants aged 65+ with dementia from 2010 to 2022, assessing quarterly opioid and gabapentinoid prescribing before and after the guideline.
Key findings
- Typical opioid prescribing fell 26.5% over the period, but the decline was not attributable to the guideline.
- Tramadol prescribing fell 27.1%, with a significant level and trend change after the guideline.
- Gabapentinoid prescribing rose from 9.5% to 11.5% with no trend change; buprenorphine stayed near zero.
Clinical relevance
Clinicians treating pain in dementia should note that prescribing shifted between analgesics rather than falling uniformly, and gabapentinoids carry their own risks in this group.
Who should care
Limitations
Observational interrupted time series cannot establish causation, and the study did not assess whether pain control or harms changed.
Review analgesic regimens in patients with dementia for gabapentinoid and tramadol use and reassess the risk-benefit of each.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
In March 2016, the Centers for Disease Control and Prevention (CDC) issued guidelines advising against opioid use for most chronic pain because of their associated risks. Evaluating how this guideline affected subsequent opioid and non-opioid analgesic prescribing in older adults with dementia is critical, as this population is at heightened risk for both pain undertreatment and adverse medication effects.
Objective
To evaluate whether the 2016 CDC opioid prescribing guideline was associated with changes in opioid and gabapentinoid prescribing in older adults with dementia.
Design
Interrupted time series analysis of a longitudinal cohort from 2010 to 2022.
Participants
Community-dwelling older adults (≥ 65 years) with dementia enrolled in the Medicare Current Beneficiary Survey (MCBS), a nationally representative survey linked to Medicare claims.
Main measures
Quarterly prescribing rates of opioids (typical opioids, tramadol, buprenorphine) and gabapentinoids (gabapentin, pregabalin) before and after CDC guideline release. Interrupted time series models estimated level (immediate) and trend (slope) changes associated with the guideline.
Key results
We identified 3246 older adults with dementia (median age [IQR] 80.7 [73.8-86.2] years; 61.4% female). Typical opioid prescribing declined by 26.5% over the study period, but the guideline was not associated with this decline (trend change: 0.09 [95% CI -0.1, 0.3] percentage points [ppts]/quarter; level change -1.5 [95% CI -4.1, 1.0] ppt). The guideline was associated with the 27.1% decrease in tramadol prescribing (trend change: -0.2 ppts/quarter [95% CI, -0.3, -0.1]; level change: -1.8 [95% CI, -3.1, -0.6] ppts). Gabapentinoid prescribing increased from 9.5% to 11.5%, with no change in trend (0.0 ppts/quarter [95% CI, -0.01 to 0.02]) after the guideline release. Buprenorphine prescribing remained near zero.
Conclusions
We identified analgesic selection shifts rather than uniform opioid reductions following the CDC guideline release, but the impact of these shifts on symptom control remains unknown. More nuanced, evidence-based analgesic prescribing guidance is needed for older adults with dementia.
DOI
10.1007/s11606-026-10932-3
PMID
42900430
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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