National patterns of cessation of prescription opioids among Medicare beneficiaries, 2013-2018

Objective: To understand the changes in opioid cessation surrounding the release of CDC guidelines and changes in state Medicaid coverage at the individual patient level. Methods: This study used a 20% national sample of Medicare beneficiaries between 2013 and 2018 with at least 90 days of consecutive opioid use in the first year of either of 2 study periods (2013-2015 or 2016-2018). Cessation of opioid use was assessed in year 3 of each period by generalized linear mixed models. Results: Opioid cessation rates were higher in period 2 (11.2%) compared to period 1 (10.1%). Adjusted for beneficiary characteristics, those in period 2 had 1.07 times the odds of cessation (95% CI: 1.05-1.09) compared to those in period 1. Additionally, the increase in opioid cessation over time was larger in states with Medicaid expansion compared to those without. Conclusion: The increase in opioid cessation after 2016 suggests the potential effects of the CDC guidelines on opioid prescribing and underscores the need for further research on the relationship between opioid cessation and subsequent change in pain control, quality of life, and opioid toxicity.