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.