Opioid prescription decreased among nursing homes between 2011 and 2022, reflecting national patterns in primary care while also possibly being an overcorrection tied to opioid-related reduction guidelines dating back to 2016.

While some nursing home residents may have benefited from opioid reductions, others may have faced barriers to adequate pain control, according to a report published Monday in JAMA Internal Medicine. Clinicians walk a fine line to ensure that residents with severe chronic pain still have their pain adequately managed while also adhering to opioid reduction initiatives, researchers said.

Out of 2.9 million nursing home residents, the adjusted probability of receiving an opioid declined from 48.1% in 2011 to 33.5% in 2022, researchers found.

The findings make sense considering efforts to bring down unnecessary opioid use across various care settings. One example: The Centers for Medicare and Medicaid Services (CMS) in 2018 proposed to survey 1,200 nursing home leaders and clinicians to evaluate medication safety and adverse drug event prevention programs, including opioid overuse and overdose.

“In 2016, over 14 million Medicare Part D beneficiaries received opioid prescriptions, and many of these beneficiaries received extreme amounts of the drugs,” CMS said in a statement from 2018. “The Medicare population has one of the highest and fastest-growing rates of diagnosed opioid use disorder.”

More recently, medication management continues to be a major focus of surveyors, with CMS concerned about unnecessary antipsychotics, among other high-risk medications.

Pain is often historically undertreated in nursing homes, the new JAMA report found. This is especially the case among racially and ethnically minoritized groups, more so than white groups.

“Minoritized residents were consistently less likely to receive opioids and higher daily MMEs [morphine milligram equivalents], suggesting that prescribing decisions may not be based solely on clinical need,” researchers said.

By 2022, the estimated probability of white residents to receive opioids was 70.2% compared to 66.6% for Black residents, according to the report.

Operators must look at current pain care in their facilities, especially for residents who are in a racial and/or ethnic minority group, in order to better manage symptoms and align with resident goals and preferences, according to the report.

Researchers examined opioid prescribing patterns between 2011 and 2022 for all residents, and by race, ethnicity and pain level. Study limitations included the inability to assess residents’ treatment preferences, focus on opioid outcomes, determining the appropriateness of prescribing, and some missing self-reported race and ethnicity data.

Medicare fee-for-service data was used, or Medicare Part A, B, and D, along with the Minimum Data Set (MDS) for long-term stay residents.