Long‐acting opioid initiation in US nursing homes

Abstract

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.

Utilization of transdermal fentanyl in German nursing home residents from 2010 to 2014

“…Several recent studies discuss the rising opioid use in the United States and Europe focusing on different settings including primary care and nursing homes …”

“…Several recent studies discuss the rising opioid use in the United States 9 and Europe 10 focusing on different settings including primary care 11 and nursing homes. 12 This present study's scope was the utilization of TF, the most frequently prescribed HPO in Germany, in the vulnerable population of nursing home residents. In our study, patients often received TF, and half of the new TF users in our study had not been regularly treated with opioids in the 180 days prior to patch initiation.…”

The double opioid crisis: A call for balance

“…Aside from the level of evidence, it is useful to know to what extent these guidelines are followed in practice. In the current issue of Pharmacoepidemiology and Drug Safety , two papers have assessed compliance with CDC recommendations . Hunnicutt et al have studied opioid prescribing in nursing homes in the United States in light of the recommendations to use immediate‐release opioids when starting treatment .…”

“…In the current issue of Pharmacoepidemiology and Drug Safety , two papers have assessed compliance with CDC recommendations . Hunnicutt et al have studied opioid prescribing in nursing homes in the United States in light of the recommendations to use immediate‐release opioids when starting treatment . Between 2011 and 2013, the initiation of opioid therapy in more than 182 000 long‐stay nursing home residents was largely aligned with the CDC prescribing guidelines, with only 2% of patients receiving long‐acting opioids at the start of therapy .…”

“…12 Between 2011 and 2013, the initiation of opioid therapy in more than 182 000 long-stay nursing home residents was largely aligned with the CDC prescribing guidelines, with only 2% of patients receiving long-acting opioids at the start of therapy. 12 Young et al studied the recommendation to prescribe the lowest effective dosage when initiating opioid therapy, while avoiding an increase in dosages of extended release and long-acting (ER/LA) opioids to 90 morphine milligram equivalents (MME) or more per day, in combination with the label recommendation to establish opioid tolerance before initiation of higher dose ER/LA opioids. 13 A large database covering over 147 million inhabitants in the United States with employerbased insurance was used to identify adult patients initiating ER/LA opioids greater than or equal to 90MME.…”