How Nursing Home Residents Got Caught in the Opioid Backlash

Since the height of the opioid epidemic, doctors have been prescribing fewer of these medications. A new study from UC San Francisco shows this trend extends to nursing home residents who may need opioids to manage chronic pain.

Analyzing data on nearly 3 million U.S. nursing home residents between 2011 and 2022, researchers found the probability of receiving an opioid declined across the board, even for nursing home residents with severe chronic pain.

The study, which uses data from the Centers for Medicare & Medicaid Services (CMS), is the first to examine opioid prescribing trends in nursing homes and to examine these trends by race, ethnicity, and pain level. It appears Nov. 3 in JAMA Internal Medicine.

... These residents are not the ones most at risk for misusing these medications.

Ulrike Muench, PhD

In 2016, the Centers for Disease Control and Prevention (CDC) released opioid guidelines designed to reduce overprescribing in outpatient care. Yet this seems to have unintentionally shifted prescribing practices in other settings.

“Older adults in nursing homes really shouldn’t be as impacted by the CDC opioid guidelines,” said the paper’s first author, Ulrike Muench, PhD, associate professor in the Department of Social and Behavioral Sciences in the UCSF School of Nursing. “The prevalence of chronic pain in nursing homes is high because of the multiple medical issues that often accompany older age, and these residents are not the ones most at risk for misusing these medications.”

The chances of nursing home residents receiving any type of opioid dropped from 48% to 33.5%, but the researchers found the reduction was not felt equally. Black, Hispanic, Asian, and American Indian or Alaska Native residents were consistently less likely than white residents to receive opioids. They also were less likely to receive higher doses of opioids, no matter their level of pain.

While the authors emphasized the importance of minimizing unnecessary opioid use, they noted that pain care is essential to healthy aging and maintaining quality of life.

“It really surprised us that even when people reported having very severe chronic pain, white nursing home residents were more likely to receive opioids — and receive them at higher doses than residents from other racial and ethnic groups,” Muench said.

Authors: Other UCSF authors include, Matthew Jura, PhD, Krista L. Harrison, PhD, Alexander K. Smith, MD, MPH, Kenneth Covinsky, MD, MPH, and Lauren J. Hunt, PhD, RN.

Funding: The study was funded by grant (3P01 AG066605-03S1) from the National Institute on Aging.