Prescription opioids (e.g. oxycodone, hydrocodone and methadone) are used to treat moderate to severe pain and can provide effective pain management when prescribed and taken as directed. However, prescription opioids can also be misused, leading to addiction, death, drug diversion (transfer of a legally prescribed controlled substance from the individual for whom it was prescribed to another person for illicit use) and a host of other problems. For senior living communities, administering opioids to frail elderly residents may be associated with an array of unwanted symptoms, including increased falls due to confusion, drowsiness, hallucinations, nausea, postural hypotension, urinary retention and vertigo. The challenge is to make sure the risks of the drugs don’t outweigh the benefits.
Rising concerns
Older adults living in long-term care settings experience a higher incidence of chronic pain than those living in the community and are prescribed opioids at approximately twice the rate. New research suggests that when hospital patients are moved to a long-term care facility, they are often given a prescription for a high-dose painkiller. The investigators found that seven out of 10 of these patients received an opioid prescription when they left the hospital, and most were for oxycodone (OxyContin). More than half of the prescriptions dispensed were high-dose – equivalent to 90 milligrams of morphine or higher – a threshold that the Centers for Disease Control and Prevention (CDC) advises doctors to “avoid” prescribing.
In response to CDC guidelines and the rising concern that pain may not be adequately treated for long-term care residents, the American Medical Directors Association (AMDA),3 which is the Society for Post-Acute and Long-Term Care Medicine, has two primary policies related to opioids in long-term care settings:
Opioid stewardship strategies
According to the AMDA, specific opioid stewardship strategies in long-term care settings should include the following:
If you have additional questions regarding opioid awareness, abuse or overdose treatment, call Risk Control Central at (800) 554-2642, ext. 5213, or email riskconsulting@churchmutual.com.
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