RPD218 - Racial & Ethnic Disparities in Analgesic Prescribing for Older Adults with Cancer Before/After 2016 CDC Guideline

Key Message : Preliminary national data suggest that the 2016 CDC opioid guideline was associated with reduced prescribing of first-line opioids and increased prescribing of less-effective gabapentinoids in older adults with advanced cancer, with variation by race and ethnicity. Findings raise concern that the guideline may have exacerbated disparities in cancer pain management.

Abstract: Background
Opioids are essential for cancer pain management, but systemic inequities may exacerbate undertreatment among racially and ethnically minoritized populations (1). In 2016, the CDC released opioid prescribing guidelines that may have inadvertently reduced access to appropriate opioid therapy for people with cancer (2). Studies have yet to examine how these guidelines may have differentially impacted marginalized groups.

Objectives
Assess the impact of the 2016 CDC guidelines on opioid prescribing for racial and ethnic minority older adults with advanced cancer.

Methods
We used Medicare claims data (2012-2021) to examine trends in opioid and gabapentinoid prescribing among adults aged ≥65 years with advanced cancer, before and after the 2016 CDC guideline. Planned analyses (to be completed by 01/2026) will apply mixed-effect logistic regression in a difference-in-differences design to further evaluate relative prescribing changes according to race and ethnicity.

Results
Among 3,216,867 older adults with advanced cancer (mean age 75.3 [7.6]; 51.8% female), 91,362 were Asian, 290,988 Black, 181,781 Hispanic, 10,651 Native American, 2,581,956 White, 60,129 Other. After the 2016 CDC guideline was implemented, mean opioid prescribing rates declined from 54.1% to 44.8% (relative change: -17.2%), with typical opioid prescribing showing the steepest decline (relative change: -22.1%). The magnitude of the relative decline in total opioid prescribing varied by race and ethnicity: Asian (-20.2%), “Other” (-21.3%), Hispanic (-17.4%), White (-17.0%), Black (-14.1%), and Native American (-14.7%). Gabapentinoid prescribing increased from 17.0% to 21.2%, with similar racial/ethnic variation. Confidence intervals and p-values are not reported due to the use of whole-population data.

Conclusion
Findings suggest that the 2016 CDC guideline may have differentially affected analgesic prescribing among racial and ethnic minority groups with advanced cancer, with Asian and Other individuals showing the greatest declines in first-line opioid prescribing. Ongoing analyses aim to clarify whether these trends reflect widening disparities in cancer pain management.

References: 1) Enzinger AC, Ghosh K, Keating NL, et al. Racial and Ethnic Disparities in Opioid Access and Urine Drug Screening Among Older Patients With Poor-Prognosis Cancer Near the End of Life. J Clin Oncol. 2023 May 10;41(14):2511-2522. doi: 10.1200/JCO.22.01413. Epub 2023 Jan 10. PMID: 36626695; PMCID: PMC10414726.

2) Rodin R, Li L, McKendrick K, et al. The 2016 CDC Opioid Guideline and Analgesic Prescribing Patterns in Older Adults With Cancer. JAMA Netw Open. 2025;8(5):e259043. doi:10.1001/jamanetworkopen.2025.9043