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Letter to the Editor| Volume 16, ISSUE 12, P1100-1102, December 01, 2015

Prescribed Doses of Opioids in Long-Term Care Facilities

Published:October 28, 2015DOI:https://doi.org/10.1016/j.jamda.2015.09.005
Prescribed Doses of Opioids in Long-Term Care Facilities
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      Recent reports have highlighted a rapid increase in opioid use in long-term care. Pitkälä et al
      • Pitkälä K.H.
      • Juola A.L.
      • Hosia H.
      • et al.
      Eight-year trends in the use of opioids, other analgesics, and psychotropic medications among institutionalized older people in Finland.
      J Am Med Dir Assoc. 2015; 16: 973-978
      reported the prevalence of regular opioid use increased from 12% to 23% in Finnish nursing homes between 2003 and 2011. Hanlon et al
      • Hanlon J.T.
      • Perera S.
      • Sevick M.A.
      • et al.
      Pain and its treatment in older nursing home hospice/palliative care residents.
      J Am Med Dir Assoc. 2010; 11: 579-583
      reported that 65% of US nursing home hospice or palliative care residents with any pain used opioids. However, neither of these studies investigated opioid doses. This is important, because opioids are associated with a range of dose-dependent adverse drug events (ADEs), including sedation, orthostatic hypotension, dizziness, cognitive impairment, constipation, and falls.
      • Weiner D.K.
      • Hanlon J.T.
      • Studenski S.A.
      Effects of central nervous system polypharmacy on falls liability in community-dwelling elderly.
      Gerontology. 1998; 44: 217-221
      Australian guidelines recommend not exceeding a 24-hour oral morphine equivalent (MEQ) dose of 100 mg for noncancer pain.

      Department of Health, Victoria. Drugs and Poisons Regulation in Victoria. Victorian Government, 2014. Available at: http://www.health.vic.gov.au/dpcs/expirydates.htm. Accessed July 21, 2015.

      , 

      Faculty of Pain Medicine. Recommendations regarding the use of opioid analgesics in patients with chronic non-cancer pain. Australian and New Zealand Anesthestics, 2015. Available at: http://www.fpm.anzca.edu.au/resources/professional-documents/documents/PM1%202010.pdf. Accessed July 21, 2015.

      Older people, including those with dementia, may be particularly susceptible to opioid ADEs. However, there is a paucity of data on prescribed opioid doses in long-term care. For this reason, we investigated the median and range of doses of different opioids prescribed to residents with and without dementia in Australian long-term care facilities.
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      References

        • Pitkälä K.H.
        • Juola A.L.
        • Hosia H.
        • et al.
        Eight-year trends in the use of opioids, other analgesics, and psychotropic medications among institutionalized older people in Finland.
        J Am Med Dir Assoc. 2015; 16: 973-978
        View in Article
        • Hanlon J.T.
        • Perera S.
        • Sevick M.A.
        • et al.
        Pain and its treatment in older nursing home hospice/palliative care residents.
        J Am Med Dir Assoc. 2010; 11: 579-583
        View in Article
        • Weiner D.K.
        • Hanlon J.T.
        • Studenski S.A.
        Effects of central nervous system polypharmacy on falls liability in community-dwelling elderly.
        Gerontology. 1998; 44: 217-221
        View in Article

      4. Department of Health, Victoria. Drugs and Poisons Regulation in Victoria. Victorian Government, 2014. Available at: http://www.health.vic.gov.au/dpcs/expirydates.htm. Accessed July 21, 2015.

        View in Article

      5. Faculty of Pain Medicine. Recommendations regarding the use of opioid analgesics in patients with chronic non-cancer pain. Australian and New Zealand Anesthestics, 2015. Available at: http://www.fpm.anzca.edu.au/resources/professional-documents/documents/PM1%202010.pdf. Accessed July 21, 2015.

        View in Article
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      7. Eastern Metropolitan Region. Opioid conversion ratio: Guide to practice 2013. Victoria, 2013. Available at: http://www.emrpcc.org.au/wp-content/uploads/2013/10/EMRPCC-Opioid-Conversion-2013-final.pdf. Accessed July 21, 2015.

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      9. Australian Pain Society. Pain in residential aged care facilities: Management strategies. Australia, 2005. Available at: http://www.apsoc.org.au/PDF/Publications/Pain_in_Residential_Aged_Care_Facilities_Management_Strategies.pdf. Accessed July 21, 2015.

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      Article info

      Publication history

      Published online: October 28, 2015

      Identification

      DOI: https://doi.org/10.1016/j.jamda.2015.09.005

      Copyright

      © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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