Opioids in Nursing Homes

Resolution and Position Statements
December 4, 2018

AMDA – The Society for Post-Acute and Long-Term Care Medicine has two primary policies related to opioids in nursing homes:

1. Provide access to opioids when indicated to relieve suffering and to
    improve or maintain function, and
2. Promote opioid tapering, discontinuation and avoidance of opioids
    when the above goals are not achievable,
    to prevent adverse events, dependence and diversion.


Specific opioid stewardship strategies in nursing homes include the following:

▪ First, nursing home practitioners who prescribe opioids should do so based on
   thoughtful interprofessional assessment indicating:
o A clear indication for opioid use
o Inadequate response to non-pharmacologic treatments
o Inadequate response to appropriate non-opioid pharmacologic treatments
o Appropriate response that justifies risks and benefits of continued opioid use
▪ Second, nursing home practitioners who manage patients prescribed opioids have a
   responsibility to minimize the risk of adverse events, dependency and diversion by:
o Never prescribing long-acting opioids for opioid naïve patients
o Tapering opioids to the lowest dose necessary to maximize functional ability
o Tapering and stopping opioids when risks outweigh benefits
o Prescribing opioids at the time of discharge in a quantity that represents the minimal amount
   necessary to transition the resident to a follow-up appointment
▪ Third, nursing home and hospice medical directors, as part of the inter-professional team, have a
   responsibility to:
o Oversee policies and processes that guide appropriate prescribing and use of opioids
o Participate in efforts to prevent opioid diversion
o Provide ongoing education related to opioid prescribing, safety and monitoring
▪ Fourth, legislation, regulations and other policies:
o That prevent needed access to opioids for relief of symptoms are unacceptable
o Should be consistent across states with respect to the nursing home resident and
   patient population
o Must promote access to substance use disorder specialists
o Must reduce barriers to obtaining medications used to treat opioid dependence


AMDA is committed to collaboration with national organizations including but not limited to the Centers for Medicare & Medicaid Services and the Centers for Disease Control to address opioid use and misuse.