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

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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.

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Journal of the American Geriatrics Society