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Prescribed Opioid Dosage for Long-Term Care Patients Must Be Monitored

The use of opioids in long-term care is prevalent.  According to a recent report, 65 percent of residents in nursing home care facilities in the US used opioids for pain.  A recent study investigated the opioid doses given to these residents due to their association with a variety of dose-dependent adverse drug events (ADEs), such as sedation, orthostatic hypotension, dizziness, cognitive impairment, constipation, and falls.  Older adults with dementia are particularly susceptible to opioid adverse drug events.  Currently, not much data exists on prescribed opioid doses in long-term care.

The study found that fentanyl was prescribed at higher doses per day than other opioids possibly due to the fact that it usually does not accumulate in renal impairment and does not possess active metabolites.  The greater use of fentanyl may also be attributable to the high marketing of the opioid.  The difference between opioid doses between people with and without dementia was not significant.  There is currently no specificity in the maximum recommended dose of 100 mg/day for older adults with noncancer pain who may be particularly vulnerable to opioid adverse drug events.  Thus, long-term care facilities must regularly monitor for opioid adverse drug events.