Use of Opioids and Opioid Potentiators Among Nursing Home Residents in the United States: National Prevalence and Correlates

BACKGROUND: Concurrent use of opioids and opioid potentiators (i.e., benzodiazepines, non-benzodiazepines, and gabapentinoids) can elevate the risks of potential harms (e.g., hospitalizations and deaths). However, no study has yet examined the co-use of opioids and opioid potentiators in US nursing homes. METHODS: We used nationally-representative data in 2019 from Minimum Data Set 3.0 (MDS 3.0) linked with Part D claims and other data sources, and measured length of opioid use in the 120 days from the index assessment (short-term users: ≤ 30 days; medium-term users: 31-89 days, and long-term users: ≥ 90 days). In this cross-sectional study design, we estimated prevalence of opioid use and co-use of opioids and opioid potentiators by duration of opioid use. We also estimated resident- and facility-level factors associated with opioid use and co-use of opioids and opioid potentiators in long-stay nursing home residents. RESULTS: Of 135,347 long-stay nursing home residents, 32,550 (24.0%) had any opioid prescriptions. 7.1% were short-term opioid users, 5.5% were mid-term opioid users, and 11.4% were long-term opioid users. Among opioid users, 52.0% also had any opioid potentiators. The most frequently used potentiator class was gabapentinoids, followed by benzodiazepines and non-benzodiazepines. Pain and other comorbid conditions (e.g., anxiety) were significantly associated with such uses (p < 0.001). Cognitive impairment and dementia were associated with lower odds of opioid use and co-use of opioid-potentiators (p < 0.01). CONCLUSIONS: Long-term opioid use in older nursing home residents remains prevalent. The co-use of opioids and opioid potentiators is also prevalent in this population. Because co-use of opioid-potentiators can pose elevated risks for potentially avoidable harms, safer opioid-related medication use needs to be emphasized in long-term care settings. Alternatives to opioid use (e.g., non-opioid pain medications and physical therapy) should be considered, and regular medication reviews and deprescribing efforts will be critical in residents taking opioids in nursing home settings.