CDC Guideline Linked to Lower Tramadol Prescribing in Older Adults With Dementia

Researchers used Medicare Current Beneficiary Survey data linked to claims to assess quarterly prescribing among community-dwelling adults aged 65 years or older with dementia. The cohort included 3,246 people (median age 80.7 years; 61.4% female). An interrupted time-series analysis estimated immediate and trend changes in prescribing after the CDC issued its 2016 opioid guideline.

Typical opioid prescribing declined by 26.5% over the study period, but the guideline was not associated with a significant level or trend change. Tramadol prescribing fell by 27.1%; the guideline was associated with an immediate decrease of 1.8 percentage points and a further quarterly trend decrease of 0.2 percentage points. Gabapentinoid prescribing rose from 9.5% to 11.5%, with no detectable trend change after guideline release. Buprenorphine prescribing remained near zero.

The findings suggest that prescribing shifts differed by analgesic rather than reflecting uniform opioid reductions. The observational design cannot establish that the guideline caused the changes, and the study did not assess pain control or other clinical outcomes. The authors note that the effects of these prescribing patterns on symptom control remain unknown.