A1397
Title: Using a generalization of the average treatment effect on the treated to better understand opioid prescription risks
Authors: Kara Rudolph - Columbia University (United States) [presenting]
Ivan Diaz - NYU Langone Health (United States)
Shodai Inose - Columbia University (United States)
Herbert Susmann - NYU Langone Health (United States)
Nicholas Williams - Columbia University (United States)
Katherine Hoffman - University of Washington (United States)
Allison Perry - NYU Langone Health (United States)
Abstract: To reduce risks associated with using prescription opioids, the US (CDC) published opioid prescribing guidelines. However, these guidelines 1) do not consider dose strength and prescription duration as a joint exposure and 2) are written as applying to all persons. However, perhaps the majority of opioid prescribing poses little risk and, therefore, is not in need of intervention. A large cohort of opioid-naive musculoskeletal pain patients on Medicaid is considered, and effects of modest reductions in opioid dose and duration prescribing practices (considered as a joint exposure) on risk of developing opioid use disorder are estimated, among patients with different prescribing levels. This causal effect is a generalization of the average treatment effect on the treated (ATT); it is the effect of a modified treatment policy among subsets for whom the policy would be relevant, based on their treatment status. A novel targeted minimum loss-based estimator is used with cross-fitting. It is found that universal reductions may have little effect on reducing opioid-related harms, and, plausibly, may even be counterproductive to the extent that their universal application results in uncontrolled pain for patients. In contrast, applying opioid prescribing guidelines to target patients with high-dose and/or long-duration prescriptions would be expected to yield much larger benefits.
