| Title | Frequency of Long-Acting Opioid Analgesic Initiation in Opioid-Naïve Nursing Home Residents. | | Author(s) | Dosa DM, Dore DD, Mor V, Teno JM | | Institution | Center for Gerontology and Health Care Research (D.M.D., V.M., J.M.T.), The Warren Alpert Medical School at Brown University; Providence Veteran's Administration Medical Center (D.M.D.); and Division of Geriatrics (D.M.D., J.M.T.), Rhode Island Hospital, Providence, Rhode Island; i3 Drug Safety (D.D.D.), Waltham, Massachusetts; and Department of Community Health (D.M.D., D.D.D., V.M., J.M.T.), Brown Medical School, Providence, Rhode Island, USA. | | Source | J Pain Symptom Manage 2009 Apr 15. | | Abstract | A U.S. Food and Drug Administration (FDA) warning against morbidity and death associated with the initiation of transdermal fentanyl in previously opioid-naïve patients has been issued. Additional warnings against opioid-naïve 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 LAO. Little is known about the frequency of opioid-naïve LAO initiation among NH residents. To ascertain the frequency of LAO 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 naïve. Furthermore, naïve initiation was more frequent among those with advanced age and those with cognitive impairment. In an exploratory multivariable logistic regression model, opioid-naïve LAO initiation was associated with a diagnosis of Alzheimer's dementia and chewing difficulties. Opioid-naïve residents were also more likely to initiate on fentanyl relative to other LAOs (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 naïve LAO initiation warrants efforts to further study the prescribing of opioids in NH residents. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19375273 |
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