Frequency of Long-Acting Opioid Analgesic Initiation in Opioid-Naive Nursing Home Residents

A U.S. Food and Drug Administration (FDA) warning against morbidity and death associated with the initiation opioid-naive patients has been. issued. Additional warnings against opioid-naive initiation are included in the package inserts for several other long-acting opioids (LAOs). Frail, older nursing home (NH) residents with renal and hepatic insufficiency have increased risk of adverse reactions from initiation of LAOs. Little is known. about the frequency of opioid-naive LAO initiation among NH-residents. To ascertain the frequency of LA 0 initiation. among residents residing in Rhode Island NHs, an analysis of 2004-2005 Rhode Island Medicaid pharmacy claims data linked. to the Minimum. Data Set was conducted. Of the 591 Medicaid residents who initiated therapy with an, LAO, 232 (39.3%) were opioid naive. Furthermore, naive initiation was more frequent among those with advanced age and those with cognitive impairment. In and exploratory multivariable logistic regression model, opioid-naive LAO initiation was associated with a diagnosis of Alzheimer's dementia and chewing difficulties. Opioid-naive residents were also more likely, to initiate on fentanyl relative to other LA Os (60.3% vs. 46.4%) and to use higher initial dosages. Given the significance of the FDA warning, including a black box warning with transdermal fentanyl this rate of naive LAO initiation warrants efforts to further study the prescribing of opioids in NH residents. J Pain Symptom Manage 2009;38:515-521. (C) 2009 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.