Participants had a median age of 80.7 years, with an interquartile range of 73.8 to 86.2 years, and 61.4% were female. From 2010 through 2022, the researchers measured quarterly prescribing rates for typical opioids, tramadol and buprenorphine, together with the gabapentinoids gabapentin and pregabalin. Using an interrupted time-series design, the researchers estimated whether the level and slope of prescribing changed after the CDC released its guideline in March 2016.

Level estimates represented immediate changes in quarterly prescribing rates, while slope estimates captured changes in those rates over time. As an observational analysis, the study assessed an association with the guideline release rather than establishing that the guideline caused the observed prescribing patterns. The results therefore do not support causal attribution of the measured changes to the guideline itself.

Typical opioid prescribing declined by 26.5% over the full study period, but the model did not identify that decline as guideline-related. The estimated change in quarterly trend was 0.09 percentage points, with a 95% confidence interval of −0.1 to 0.3 percentage points, while the estimated immediate level change was −1.5 percentage points, with a 95% confidence interval of −4.1 to 1.0 percentage points. The study thus distinguished the overall decline observed from 2010 to 2022 from the changes statistically associated with the intervention period.

Tramadol showed a different post-guideline pattern. Guideline release was associated with a 27.1% decrease in tramadol prescribing, expressed in the model as an immediate level change of −1.8 percentage points and a trend change of −0.2 percentage points per quarter. Both estimates had 95% confidence intervals that excluded zero: −3.1 to −0.6 percentage points for the level change and −0.3 to −0.1 percentage points for the trend change.

These findings support a selective association between the guideline period and lower tramadol prescribing, rather than a general reduction across opioid categories. Gabapentinoid prescribing, meanwhile, increased from 9.5% to 11.5% during the study period, with no modeled change in trend after the guideline release. The estimated trend change was 0.0 percentage points per quarter, with a 95% confidence interval of −0.01 to 0.02 percentage points.

Buprenorphine prescribing remained near zero throughout. Because the study measured medication use rather than pain relief, adverse effects or symptom control, it could not determine whether the observed analgesic shifts benefited patients or reduced medication-related harm. The population also has heightened exposure to the competing concerns identified in the study’s rationale: the risk of pain undertreatment and the risk of adverse medication effects.

However, the research did not directly compare those outcomes, and its scope was limited to community-dwelling older adults with dementia represented in a national survey. The findings therefore offer no direct evidence about pain treatment or safety outcomes. The authors concluded that the results show analgesic selection shifts after the guideline release, that the clinical impact of those shifts remains unknown, and that more nuanced, evidence-based analgesic prescribing guidance is needed for older adults with dementia.

Subject of Research: Changes in opioid and gabapentinoid prescribing among community-dwelling older adults with dementia after the 2016 CDC opioid prescribing guideline

Article Title: Opioid and Gabapentinoid Prescribing in Older Adults with Dementia Before and After the 2016 CDC Opioid Prescribing Guideline

Article References: Veschio, T., McKendrick, K., Li, L., Harrison, K., Hunt, L. J., Muench, U., Smith, C. B., Aldridge, M., Sean Morrison, R., & Rodin, R. (2026). Opioid and Gabapentinoid Prescribing in Older Adults with Dementia Before and After the 2016 CDC Opioid Prescribing Guideline. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10932-3

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10932-3

Keywords: dementia, opioid prescribing, CDC guideline, gabapentinoids, tramadol, older adults, Medicare claims, interrupted time series, pain treatment, Opioid, Gabapentinoid, Prescribing