Long-acting opioid initiation in US nursing homes

Area of Science:

• Geriatric Medicine
• Pain Management
• Health Services Research

Background:

• Opioid initiation in nursing home residents requires careful consideration due to potential risks.
• Understanding patterns of initiating short-acting versus long-acting opioids is crucial for appropriate pain management.
• Variations in prescribing practices may exist based on geographic location and resident demographics.

Purpose of the Study:

• To determine the proportion of nursing home residents initiating long-acting opioids compared to short-acting opioids.
• To investigate regional variations in long-acting opioid initiation across the United States.
• To examine how resident characteristics influence the initiation of long-acting opioids.

Main Methods:

• A cross-sectional study analyzed Medicare Part D prescription claims for 182,735 long-stay nursing home residents (2011-2013).
• Residents initiating opioids (short- or long-acting) with no prior prescriptions in 60 days were identified.
• Logistic models assessed associations between resident characteristics and long-acting opioid initiation, with regional mapping.

Main Results:

• Only 2% of opioid initiators in nursing homes were prescribed long-acting opioids.
• Significant state-level variation in long-acting opioid initiation was observed (0.6% to 7.5%).
• Severe physical limitations and assessed pain were associated with increased long-acting opioid initiation, while being non-White was inversely associated.

Conclusions:

• The majority of US nursing home residents initiate short-acting opioids, aligning with CDC guidelines.
• Geographic and resident-specific variations in long-acting opioid initiation highlight potential areas for practice improvement.
• Further research can optimize opioid prescribing strategies in long-term care settings.