TOPLINE: 

Opioid prescribing in US nursing homes decreased from 2011 to 2022, affecting residents across various levels of chronic pain. Minoritized residents were less likely to receive opioids or to have higher daily morphine milligram equivalents than White residents.

METHODOLOGY:

• Researchers analyzed opioid prescribing patterns among nursing home residents using 100% Medicare fee-for-service data from 2011 to 2022.
• Overall, 2.9 million unique long-stay nursing home residents (mean age, 84.2 years) in the United States were included.
• Measured outcomes included the receipt of any opioid and daily morphine milligram equivalents greater than 50 over 90 days.
• Race and ethnicity were identified using the Research Triangle Institute algorithm, and subgroup analyses were performed for residents with no, mild-to-moderate, or severe chronic pain.

TAKEAWAY:

• The adjusted probability of receiving any opioid among nursing home residents decreased from 48.1% in 2011 to 33.5% in 2022.
• Among residents who received opioids, the proportion of those with daily morphine milligram equivalents more than 50 decreased from 25.1% to 21.9%.
• By 2022, White residents had the highest adjusted probability of receiving opioids (48.4%) and having morphine milligram equivalents greater than 50 (25.9%). Opioid prescribing declined across all racial and ethnic groups, regardless of pain level.
• By 2022, minoritized residents were less likely than White residents to receive opioids (Black vs White residents, 66.6% vs 70.2%) or to reach higher morphine milligram equivalent levels (Hispanic vs White residents, 20.5% vs 28.7%).

IN PRACTICE:

"[O]pioid reductions among residents with severe chronic pain warrant evaluation to ensure pain is adequately managed," the authors wrote. "Our findings highlight the need to assess whether current pain care in NH [nursing home] populations, particularly in minoritized residents, optimally manages symptoms and aligns with residents' goals and preferences," they added.

SOURCE:

This study was led by Ulrike Muench, PhD, of the Department of Social and Behavioral Sciences, School of Nursing at the University of California in San Francisco. It was published online on November 3, 2025, in JAMA Internal Medicine.

LIMITATIONS: 

The treatment preferences of the residents could not be evaluated. Self-reported data on race and ethnicity may be missing, and the study focused exclusively on opioid outcomes.

DISCLOSURES:

The study was funded by the National Institute on Aging. Some authors disclosed receiving grants from the National Institute on Aging during the conduct of the study, and one of them also reported receiving grants from the Health Resources and Services Administration.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.