1. Insurance data suggests state laws have little impact on opioid prescribing practices
Abstract: https://www.acpjournals.org/doi/10.7326/M 21-4363
URL goes live when the embargo lifts
A new study of adults with chronic noncancer pain found that state laws designed to govern opioid prescribing have had very little effect on opioid prescribing or nonopioid pain treatment. The study is published in Annals of Internal Medicine.
In response to the opioid crisis, clinical guidelines emphasize the use of nonopioid treatment or low doses of opioids when clinically necessary. Many states have passed laws designed to curb opioid prescribing trends but opponents argue that those laws restrict prescribers' clinical judgment, impose an administrative burden, and may have adverse effects on patients. However, the laws' effects are unclear because of challenges in disentangling multiple laws implemented around the same time.
Researchers from Johns Hopkins Bloomberg School of Public Health studied commercial insurance claims data for 7,694,514 adults in 13 ‘treatment states’ that had enacted one of four types of opioid prescribing laws and implemented no other related laws two years before or after enacting the law of interest. These laws include opioid prescribing cap laws, pill mill
laws, mandatory prescription drug monitoring program (PDMP) query laws, and mandatory PDMP enrollment laws. These states were individually matched with states that did not enact laws during the study timeframe to determine if these laws affected trends in opioid and guideline-concordant nonopioid pain treatment. The data showed that opioid prescribing laws were each associated with a less-than one percent change in opioid prescribing trends during the first two years of implementation. According to the authors, these findings suggest that the decreasing volume of opioid prescribing in the United States may be driven more by shifting clinical guidelines, professional norms, or other factors than by opioid prescribing laws.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org . To speak with the corresponding author, Emma E. McGinty, PhD, MS please contact Caitlin Hoffman at choffman@jhu.edu .
-------------------------------------------------
2. No clear answer on aspirin cessation among healthy older adults
Post hoc analysis of ASPREE trial should be weighed against findings of original trial
Abstract: https://www.acpjournals.org/doi/10.7326/M 21-3823
Editorial: https://www.acpjournals.org/doi/10.7326/M 22-0550
A post-hoc subgroup analysis of the ASPREE (ASPirin in Reducing Events in the Elderly) trial found no clear harm or benefit to continuing or stopping aspirin use in older adults with no comorbidities. While cessation may reveal an underlying issue, such as coronary disease, or precipitate an event, such as myocardial infarction, continuing treatment increases bleeding risk. The limits imposed by the study design are such that clinicians should interpret the findings within the context of the original study. The analysis is published in Annals of Internal Medicine.
The ASPREE trial was a primary prevention trial of 19,114 aspirin-using adults aged 70 years and older. The results of the trial demonstrated that aspirin had no benefit for disability-free survival, prevention of cardiovascular disease events, or prevention of incident cancer, and increased risk for major bleeding and all-cause mortality.
Researchers from the University of Tasmania conducted a post-hoc subgroup analysis of 1,714 adults aged 70 years or older taking aspirin 2 or more days a week before enrollment of the ASPREE trial. The authors compared outcomes between patients who ceased and patients who continued aspirin usage. Over a follow up period of 4.9 years, the authors found that patients who ceased aspirin use experienced increased rates of all-cause mortality, incident dementia, persistent physician disability, and cardiovascular events, but the wide confidence intervals deemed the findings inconclusive. The authors reported that no substantial increased risks for major hemorrhage and cancer were seen with continued aspirin use. The authors note that the absence of an effect on hemorrhage may relate to self-selection for tolerance among aspirin users.
An accompanying editorial from authors at the National University of Ireland advise that this ASPREE trial analysis alone should not be used as a justification for continuing primary prevention aspirin in adults over 70 years of age. However, the authors also note that chronological age alone may not be the best way to make this decision. Instead, they suggest an annual approach that considers age, comorbidities, competing risk of non-cardiovascular disease death, and bleeding risk. The authors also emphasize that the 2019 ACC/AHA primary prevention guideline recommendation on aspirin use among older adults included the term “on a routine basis,” specifically to allow clinicians and patients some room to consider continuing aspirin among these patients.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org . To speak with the corresponding author, Mark R. Nelson, MBBS(Hons), MFM, PhD, please contact Angela Wilson at angela.wilson@utas.edu.au .
3. New reporting tool improves standardization, transparency of adapted healthcare guidelines
Abstract: https://www.acpjournals.org/doi/10.7326/M21-4352
A scientific workgroup developed a new reporting tool designed to improve standardization and transparency of adapted health care guidelines. Called the RIGHT-Ad@pt Checklist, the tool focuses on improving the clarity and explicitness of recommendations that have been adapted for use in different health care systems, and of their development process. Authors from the Iberoamerican Cochrane Centre and the American University of Beirut, in collaboration with 119 expert researchers from 6 continents and 42 countries, describe the Checklist in an article published in Annals of Internal Medicine.
To maximize the efficiency of resources and reduce redundancy, organizations and countries may decide to adapt an existing practice guideline rather than developing a new one. The RIGHT (Reporting Items for practice Guidelines in HealThcare) statement currently informs the reporting of the guideline development; however, it does not cover reporting of steps that are specific to guideline adaptation.
The RIGHT-Ad@pt Checklist was developed as an extension of the RIGHT statement through a multi-step process involving literature reviews and consensus building involving a range of stakeholders including guideline adaptation experts, users, journal editors, and policy makers. The checklist was designed to be used to guide the reporting of adapted guidelines, including adaptation process and the adapted recommendations. It can also be applied to assess the completeness of reporting and, in combination with available adaptation frameworks, to inform adaptation processes. Different audiences may use the RIGHT-Ad@pt checklist for different purposes:
The authors say that future research should address the completeness of adapted guidelines and whether the publication of RIGHT-Ad@pt will have an influence on reporting, the quality of adapted guidelines, or the efficiency of the adaption process.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org . To speak with the corresponding authors, Pablo Alonso-Coello, MD, PhD, or Elie A. Akl, MD, MPH, PhD, please contact Laia Cendrós at lcendros@santpau.cat or Ms. Rana Ahmad at ra257@aub.edu.lb .
Annals of Internal Medicine
Data/statistical analysis
People
Effects of State Opioid Prescribing Laws on Use of Opioid and Other Pain Treatments Among Commercially Insured U.S. Adults
15-Mar-2022