Abstract
Objective
Policies and regulations on opioid use have evolved from being primarily state-to
federally based. We examined the trends and variation in chronic opioid use among
states and nursing homes.
Design
Retrospective cohort study.
Setting and Participants
We used the nursing home Minimum Data Set and Medicare claims from 2014 to 2018 and
included long-term care nursing home residents from each year who had at least 120 days
of consecutive stay.
Measurements
Chronic opioid use was defined as use for ≥90 days. Three-level hierarchical logistic
regression models (resident, nursing home, state) were constructed to estimate intraclass
correlation coefficient (ICC) at the state level and at the nursing home level. The
ICC shows the proportion of variation in chronic opioid use that is attributable to
states or nursing homes. All models were constructed separately for each calendar
year and controlled for resident, nursing home, and state characteristics.
Results
We included 3,245,714 nursing home stays from 2014 to 2018, representing 1,502,131
unique residents. The stays ranged from 676,413 in 2014 to 594,874 in 2018, with residents
contributing a maximum of 1 stay per year. Chronic opioid use among nursing home residents
declined from 14.1% in 2014 to 11.4% in 2018. The variation (ICC) in chronic opioid
use among states declined from 2.5% in 2014 to 1.7% in 2018. In contrast, the variation
(ICC) among nursing homes increased from 5.6% in 2014 to 6.5% in 2018.
Conclusions and Implications
Variation in chronic opioid use declined by one-third at the state level but not at
the nursing home level. National guidelines on opioid use and federal policies on
opioid use may have contributed to reducing state-level variation in chronic opioid
use.
Keywords
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Article info
Publication history
Published online: May 19, 2021
Footnotes
This work was supported by the National Institutes of Health (5R01DA039192, 3R01DA039192-03S1, and K24AG056578), National Cancer Institute (K05-CA134923), and the Claude D. Pepper Older Americans Independence Center Award (P30-AG024832-12).
G. Caleb Alexander previously served as chair of the FDA Peripheral and Central Nervous System Advisory Committee and as a paid advisor to IQVIA; is a consultant and holds equity in Monument Analytics, a health care consultancy whose clients include the life sciences industry as well as plaintiffs in opioid litigation; and is a member of OptumRx's National P&T Committee. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies.
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
