Table 2.

Characteristics of opioids, nonopioid pharmacologic alternatives, and potentially contraindicated psychopharmacologic medications prescribed during 120 days of follow-up in long-stay nursing home residents in 2012 (N=315,949).

Medication use during follow-upa	No opioid use (n=213,652)	Length of opioid useb
		Short-term (n=32,841)	Medium-term (n=20,615)	Long-term (n=48,841)
Opioid usec
Median number opioid claims, (IQR)	-	1 (1–2)	5 (3–7)	6 (5–10)
Duration of action
Short-acting only	-	99.0	94.5	65.7
Long-acting only	-	0.6	1.8	12.5
Short- and long-acting	-	0.4	3.6	21.8
Average daily dose (in oral morphine equivalents)d
<50 mg/day	-	78.4	77.2	68.1
50–89 mg/day	-	18.4	19.0	15.9
≥90 mg/day	-	3.3	3.8	16.0
Dosage forme
Oral	-	99.5	98.8	91.5
Injection	-	0.2	0.1	0.1
Transdermal	-	0.7	3.6	24.3
Other	-	0.01	0.0	0.0
Nonopioid pharmacologic alternatives
Standalone prescription NSAIDS	8.4	15.3	17.5	16.0
Any pain adjuvants and/or other medications used for painf	23.4	41.4	50.3	50.3
Pain adjuvants	14.9	27.6	34.7	35.7
Anticonvulsants	9.7	19.7	25.5	25.4
Antidepressants	6.4	11.6	15.6	17.1
Other medications used for pain	11.0	21.8	27.4	27.2
Corticosteroids	6.5	11.2	13.1	12.2
Muscle relaxants	2.7	6.6	9.1	9.6
Transdermal Lidocaine	2.4	6.2	9.2	9.5
Potentially contraindicated medication useg
Any anxiolytic or hypnotic use	17.5	27.6	35.5	32.7
≥2 antipsychotic, anxiolytic and/or hypnoticg	8.0	11.5	14.8	13.5

Abbreviations: ER: extended release; IQR: interquartile range; PRN: pro re nata; NSAIDS: nonsteroidal anti-inflammatory agents

^aNumbers are percentages unless otherwise noted. Percentages may not add up to 100% due to rounding

^bBased on MDS assessments during follow-up, prevalence of scheduled and PRN analgesics use varied by short- (scheduled: 43.5%, PRN: 42.0%), medium- (scheduled: 77.6%, PRN: 47.6%) and long-term users (scheduled:97.0%, PRN: 29.5%).

^cShort-acting opioids included codeine, dihydrocodeine, hydrocodone, hydromorphone, meperidine, morphine, nalbuphine, oxycodone, oxymorphone, pentazocine, tapentadol, and tramadol. Long-acting opioids included buprenorphine, butorphanol, transdermal fentanyl, hydromorphone extended release (ER), methadone, morphine ER, oxycodone ER, oxymorphone ER, tapentadol ER, and tramadol ER

^dCalculated by estimating average daily dose of each unique opioid prescription, converting each prescription to oral morphine equivalents, summing the oral morphine equivalents for all prescriptions, and dividing by the estimated cumulative days of opioid use.

^ePercentages add up to >100% because some participants used multiple opioids with different dosage forms

^fAntidepressents commonly used as adjuvants included desipramine, nortriptyline, amitriptyline, duloxetine, venlafaxine and milnacipran.²⁶ Anticonvulsants included carbamazepine, gabapentin, lamotrigine, pregabalin. Corticosteroids included dexamethasone, prednisone, prednisolone, and methylprednisolone. Muscle relaxants included baclofen, carisoprodol, chlorzoxazone, cyclobenzaprine, dantrolene, metaxolone, methocarbamol, orphenadrine, and tizanidine.

^gDefined using the Minimum Data Set during 120-day follow-up (excludes the index MDS assessment).