New Initiation of Long-Acting Opioids in Long-Stay Nursing Home Residents

J Am Geriatr Soc. 2016 Sep;64(9):1772-8. doi: 10.1111/jgs.14306. Epub 2016 Aug 3.

Abstract

Objectives: To estimate the prevalence of new initiation of long-acting opioids since introduction of national efforts to increase prescriber and public awareness on safe use of transdermal fentanyl patches.

Design: Cross-sectional.

Setting: U.S. nursing homes (NHs).

Participants: Medicare-enrolled long-stay NH residents (N = 22,253).

Measurements: Minimum Data Set 3.0 was linked with Medicare enrollment, hospital claims, and prescription drug transaction data (January-December 2011) and used to determine the prevalence of new initiation of a long-acting opioid prescribed to residents in NHs.

Results: Of NH residents prescribed a long-acting opioid within 30 days of NH admission (n = 12,278), 9.4% (95% confidence interval = 8.9-9.9%) lacked a prescription drug claim for a short-acting opioid in the previous 60 days. The most common initial prescriptions of long-acting opioids were fentanyl patch (51.9% of opioid-naïve NH residents), morphine sulfate (28.1%), and oxycodone (17.2%).

Conclusion: New initiation of long-acting opioids-especially fentanyl patches, which have been the subject of safety communications-persists in NHs.

Keywords: analgesics; long-acting opioid; nursing home.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Administration, Cutaneous
  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / adverse effects
  • Buprenorphine / administration & dosage
  • Buprenorphine / adverse effects
  • Chronic Pain / drug therapy*
  • Delayed-Action Preparations
  • Dose-Response Relationship, Drug
  • Drug Utilization / statistics & numerical data
  • Female
  • Fentanyl / administration & dosage*
  • Fentanyl / adverse effects*
  • Homes for the Aged*
  • Humans
  • Long-Term Care
  • Male
  • Morphine / administration & dosage*
  • Morphine / adverse effects
  • Nursing Homes*
  • Oxycodone / administration & dosage*
  • Oxycodone / adverse effects
  • Oxymorphone / administration & dosage
  • Oxymorphone / adverse effects
  • Practice Patterns, Physicians' / statistics & numerical data
  • Practice Patterns, Physicians' / trends
  • Rhode Island
  • Tramadol / administration & dosage
  • Tramadol / adverse effects

Substances

  • Analgesics, Opioid
  • Delayed-Action Preparations
  • Tramadol
  • Buprenorphine
  • Morphine
  • Oxymorphone
  • Oxycodone
  • Fentanyl