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In a  of Blue Cross and Blue Shield enrollees reported last week in the New England Journal of Medicine, initial opioid prescriptions declined 54 percent between July 2012 and December 2017, while the number of providers who initiated opioid therapy in any patient who had not used opioids declined by 29 percent. The incidence of long-duration and high-dose initial opioid prescriptions also declined over the study period. “Notably, these downward trends began long before the release of the CDC [Centers for Disease Control and Prevention] guidelines in March 2016 (or even the draft guidelines in December 2015), indicating that the CDC guidelines were not the sole precipitating force behind the declines,” the authors said. In March 2016, CDC finalized guidance for primary care physicians prescribing opioids to adults for chronic pain in outpatient settings, which emphasized limiting the use, duration and dose of opioids for first-time users.