ReviewPharmacoepidemiology and drug safety2019
Methodologic limitations of prescription opioid safety research and recommendations for improving the evidence base.
Review in Pharmacoepidemiology and drug safety, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- [Recommendations of the second update of the LONTS guidelines : Long-term opioid therapy for chronic noncancer pain].Schmerz (Berlin, Germany) · 2020Pooled it
- Long-term opioid therapy definitions and predictors: A systematic review.Pharmacoepidemiology and drug safety · 2020Pooled it
- The Association Between Rapid Opioid Dose Tapering and Polydrug Overdose Deaths Among High-Dose, Long-Term Opioid Therapy Recipients.Journal of general internal medicine · 2025Article
- Abuse-deterrent formulations and opioid-related harms in North Carolina, 2010-2018.American journal of epidemiology · 2025Article
- Comparison of Different Modeling Approaches for Prescription Opioid Use and Its Association With Adverse Events.American journal of epidemiology · 2023Article
- Development and validation of an electronic health records-based opioid use disorder algorithm by expert clinical adjudication among patients with prescribed opioids.Pharmacoepidemiology and drug safety · 2023Article
- Evaluating opioid analgesic prescribing limits: A narrative review.Pharmacoepidemiology and drug safety · 2022Review
- Association of Opioid Dose Reduction With Opioid Overdose and Opioid Use Disorder Among Patients Receiving High-Dose, Long-term Opioid Therapy in North Carolina.JAMA network open · 2022Article
- Inches, Centimeters, and Yards: Overlooked Definition Choices Inhibit Interpretation of Morphine Equivalence.The Clinical journal of pain · 2021Article
- European* clinical practice recommendations on opioids for chronic noncancer pain - Part 1: Role of opioids in the management of chronic noncancer pain.European journal of pain (London, England) · 2021Article
- Article
- Cancer survivorship and its association with perioperative opioid use for minor non-cancer surgery.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2020Article
- Patient race and opioid misuse history influence provider risk perceptions for future opioid-related problems.The American psychologist · 2020Article
- The role of substance use disorders in experiencing a repeat opioid overdose, and substance use treatment patterns among patients with a non-fatal opioid overdose.Drug and alcohol dependence · 2020Observational
- Conversion to Persistent or High-Risk Opioid Use After a New Prescription From the Emergency Department: Evidence From Washington Medicaid Beneficiaries.Annals of emergency medicine · 2019Article
- Article
- Post-marketing studies of pharmaceutical opioid abuse-deterrent formulations: a framework for research design and reporting.Addiction (Abingdon, England) · 2019Article
- The double opioid crisis: A call for balance.Pharmacoepidemiology and drug safety · 2019Article
- The Current State of Deep Brain Stimulation for Chronic Pain and Its Context in Other Forms of Neuromodulation.Brain sciences · 2018Review
- Management of Pain in the United States-A Brief History and Implications for the Opioid Epidemic.Health services insights · 2018Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
purposeThe ongoing opioid epidemic has claimed more than a quarter million Americans' lives over the past 15 years. The epidemic began with an escalation of prescription opioid deaths and has now evolved to include secondary waves of illicit heroin and fentanyl deaths, while the deaths due to prescription opioid overdoses are still increasing. In response, the Centers for Disease Control and Prevention (CDC) moved to limit opioid prescribing with the release of opioid prescribing guidelines for chronic noncancer pain in March 2016. The guidelines represent a logical and timely federal response to this growing crisis. However, CDC acknowledged that the evidence base linking opioid prescribing to opioid use disorders and overdose was grades 3 and 4.
methodsMotivated by the need to strengthen the evidence base, this review details limitations of the opioid safety studies cited in the CDC guidelines with a focus on methodological limitations related to internal and external validity.
resultsInternal validity concerns were related to poor confounding control, variable misclassification, selection bias, competing risks, and potential competing interventions. External validity concerns arose from the use of limited source populations, historical data (in a fast-changing epidemic), and issues with handling of cancer and acute pain patients' data. We provide a nonexhaustive list of 7 recommendations to address these limitations in future opioid safety studies.
conclusionStrengthening the opioid safety evidence base will aid any future revisions of the CDC guidelines and enhance their prevention impact.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.