Long-acting opioid initiation in US nursing homes

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Epidemiology | Geriatrics | Health Services Administration | Health Services Research | Medical Pharmacology | Pharmaceutical Preparations | Pharmacy and Pharmaceutical Sciences | Therapeutics


PURPOSE: To estimate the proportion of residents newly initiating long-acting opioids in comparison to residents initiating short-acting opioids and examine variation in long-acting opioid initiation by region and resident characteristics.

METHODS: This cross-sectional study included 182 735 long-stay nursing home residents in 13 881 US nursing homes who were Medicare beneficiaries during 2011 to 2013 and initiated a short-acting or long-acting opioid (excluding residents < 50 years old, those with cancer, or receiving hospice care). Medicare Part D prescription claims were used to identify residents as newly initiating short-acting or long-acting opioids, defined as having a prescription claim for an opioid with no prior opioid prescriptions in the preceding 60 days. We estimated the overall proportion of initiators prescribed long-acting opioids. Regional variation was examined by mapping results by state and hospital referral regions. Logistic models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

RESULTS: Two percent of opioid initiators were prescribed long-acting opioids. State variation in long-acting opioid initiation ranged from 0.6% to 7.5% (5th-95th percentiles: 0.6-6.4%). Resident characteristics associated with increased long-acting opioid initiation included severe physical limitations (vs none/mild limitations; aOR: 2.13, 95% CI: 1.92-2.37) and pain (staff-assessed vs no pain; aOR: 1.59 95% CI: 1.40-1.80), whereas being non-White was inversely associated (non-Hispanic black vs non-Hispanic white; aOR: 0.70, 95% CI: 0.62-0.79).

CONCLUSION: United States nursing home residents predominantly initiate short-acting opioids in accordance with Center for Disease Control and Prevention guidelines. Documented variation by geographic and resident characteristics suggests that improvements are possible.


long-acting opioids, long-term care, nursing homes, pharmacoepidemiology, prescription opioids

DOI of Published Version



Pharmacoepidemiol Drug Saf. 2018 Jun 4. doi: 10.1002/pds.4568. [Epub ahead of print] Link to article on publisher's site

Journal/Book/Conference Title

Pharmacoepidemiology and drug safety

PubMed ID


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Link to Article in PubMed