State Variation in Chronic Opioid Use in Long-Term Care Nursing Home Residents.

The study used Medicare Part D days supplied. It counted prescriptions, not whether residents actually took the opioids. It did not examine variation by individual prescriber. Chronic opioid use was measured over a 120-day stay, so longer stays were not captured. The analysis did not consider opioid dose. Nursing homes with fewer than 20 residents were excluded, so small facilities may not be represented. The study is observational, so it cannot show that policies caused the decline in opioid use. Residents receiving hospice care were excluded, and the included residents were relatively healthier, so findings may not apply to end-of-life care.

Publication metadata lists NIH extramural research support. Dr. Alexander previously served as Chair of the FDA Peripheral and Central Nervous System Advisory Committee, has served as a paid advisor to IQVIA, is a consultant and holds equity in Monument Analytics, a health care consultancy whose clients include the life sciences industry as well as plaintiffs in opioid litigation, and is a member of OptumRx's National P&T Committee. This arrangement has been reviewed and approved by Johns Hopkins University. All authors report no conflicts of interest.

Do not read the decline in chronic opioid use as proof that federal policies caused it or that nursing home prescribing became uniform. The study is observational, and variation among nursing homes increased.