# Dementia and the opioid epidemic: The impact of the 2016 CDC guidelines on disparities in pain management

> **NIH NIH R03** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2024 · $338,000

## Abstract

PROJECT SUMMARY/ABSTRACT
The research proposed in this application aims to study the impact of the publication of the 2016 Centers for
Disease Control and Prevention (CDC) analgesic prescribing guidelines on disparities in opioid utilization
among older adults who have opioid-responsive pain. These CDC guidelines were published at that time to
help curb the rising number of overdose-related deaths related to prescription and illicit opioids, which have
caused the death of over half a million people in the United States since 1999. The guidelines recommended
cautious use or avoidance of opioid medications in persons with chronic, non-cancer pain and those not near
the end of life. However, preliminary evidence suggests that these guidelines may have had an unintended
effect of limiting access to legitimate and medically necessary opioids in people with serious illnesses. This is
of particular concern among vulnerable subgroups of older adults known to be risk of pain undertreatment. Our
analyses will focus on three highly vulnerable subgroups of older adults who have been found to be at
increased risk of pain undertreatment – persons with Alzheimer’s and related dementias (PW-ADRD), those
identifying as racial/ethnic minoritized individuals, and those experiencing socioeconomic deprivation. For each
of these three subgroups, we will employ two models of opioid-responsive pain conditions – chronic cancer
pain and acute pain from orthopedic trauma – for which the CDC guidelines were not intended to apply and for
which opioids remain a mainstay of therapy for pain control. These two conditions are common in older adults
and are often associated with moderate to severe pain. For each of the three subgroups of older adults, we will
utilize the Medicare Current Beneficiary Survey (MCBS) to obtain sociodemographic and clinical information on
opioid prescribing from 2010 to 2020. MCBS is a longitudinal survey of a nationally representative sample of
the Medicare population, with data collected three times per year over a 4-year period and approximately
15,000 respondents each year, and includes linked fee-for-service Medicare Part A and B claims, participant-
reported prescribed medicines, and records of Medicare Part D pharmacy events. We will use a difference-in-
differences design to compare the unintended impact of the 2016 CDC guidelines on opioid utilization from
2010-2020 in the following groups of older adults who have either cancer or hip or pelvic fracture: PW-ADRD
compared to persons without ADRD (Aims 1-3), those with self-reported income at or below the federal poverty
line, compared to individuals with higher income (Aim 2), and racial/ethnic minoritized older adults compared to
white older adults (Aim 3).

## Key facts

- **NIH application ID:** 10975648
- **Project number:** 1R03AG082996-01A1
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** Rebecca Anne Rodin
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $338,000
- **Award type:** 1
- **Project period:** 2024-09-17 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10975648

## Citation

> US National Institutes of Health, RePORTER application 10975648, Dementia and the opioid epidemic: The impact of the 2016 CDC guidelines on disparities in pain management (1R03AG082996-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10975648. Licensed CC0.

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