Oral Opioid Prescribing Trends in the United States, 2002–2018

Abstract Objective To conduct a retrospective analysis of sequential cross-sectional data of opioid prescribing practices in patients with no prior history of opioid use. Methods Individuals filling an oral opioid prescription who had 1 year of prior observation were identified from four different administrative claims databases for the period between January 1, 2002, and December 31, 2018: IBM MarketScan® Commercial Database (CCAE), Multi-State Medicaid Database (MDCD), Medicare Supplemental Database (MDCR), and Optum© De-Identified Clinformatics® Data Mart Database. Outcomes included incidence of new opioid use and characteristics of patients’ first opioid prescription, including dispensed morphine milligram equivalent (MME) per day, total MME dispensed, total MME ≥300, and days’ supply of prescription for ≤3 or ≥30 days. Results There were 40,600,696 new opioid users identified. The incidence of new opioid use in the past 17 years ranged from 6% to 11% within the two commercially insured databases. Incidence decreased over time in MDCD and was consistently higher in MDCR. Total MME dispensed decreased in MDCD and increased in CCAE, with no major changes in the other databases. The proportion of patients receiving ≥30-day prescriptions decreased and the proportion of patients receiving ≤3-day prescriptions increased in MDCD, while ≥30-day prescriptions in the Optum database dramatically increased (low of 3.0% in 2003 to peak of 16.9% in 2017). Conclusions Opioid prescribing practices varied across different populations of insured individuals during the past 17 years. The most substantial changes in opioid prescriptions over time have occurred in MDCD, with reductions in use across multiple metrics.

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Current Opioid Prescribing Patterns after Microdirect Laryngoscopy

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419877912 ◽

2019 ◽

Vol 129 (2) ◽

pp. 142-148 ◽

Cited By ~ 2

Author(s):

Molly N. Huston ◽

Rouya Kamizi ◽

Tanya K. Meyer ◽

Albert L. Merati ◽

John Paul Giliberto

Keyword(s):

The United States ◽

Opioid Abuse ◽

Prescribing Patterns ◽

Opioid Analgesia ◽

Opioid Use ◽

Prescribing Practices ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Opioid Prescription ◽

Opioid Prescribing

Background: The prevalence of opioid abuse has become epidemic in the United States. Microdirect laryngoscopy (MDL) is a common otolaryngological procedure, yet prescribing practices for opioids following this operation are not well characterized. Objective: To characterize current opioid-prescribing patterns among otolaryngologists performing MDL. Methods: A cross-sectional survey of otolaryngologists at a national laryngology meeting. Results: Fifty-eight of 205 physician registrants (response rate 28%) completed the survey. Fifty-nine percent of respondents were fellowship-trained in laryngology. Respondents performed an average of 13.3 MDLs per month. Thirty-four percent of surgeons prescribe opioids for over two-thirds of their MDLs, while only 7% of surgeons never prescribe opioids. Eighty-eight percent of surgeons prescribed a combination opioid and acetaminophen compound, hydrocodone being the most common opioid component. Many surgeons prescribe non-opioid analgesics as well, with 70% and 84% of surgeons recommending acetaminophen and ibuprofen after MDL respectively. When opioids were prescribed, patient preference, difficult exposure and history of opioid use were the most influential patient factors. Concerns of opioid abuse, the physician role in the opioid crisis, and literature about postoperative non-opioid analgesia were also underlying themes in influencing opioid prescription patterns after MDL. Conclusions: In this study, over 90% of practicing physicians surveyed are prescribing opioids after MDL, though many are also prescribing non-opioid analgesia as well. Further studies should be completed to investigate the needs of patients following MDL in order to allow physicians to selectively and appropriately prescribe opioid analgesia postoperatively.

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Patterns of Long-Term Prescription Opioid Use Among Older Adults in the United States: A Study of Medicare Administrative Claims Data

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.31-40 ◽

2020 ◽

Vol 1;24 (1;1) ◽

pp. 31-40

Keyword(s):

Older Adults ◽

Claims Data ◽

The United States ◽

Prescription Opioid ◽

Administrative Claims ◽

Medicare Beneficiaries ◽

Opioid Use ◽

Opioid Prescription ◽

Administrative Claims Data

BACKGROUND: Long-term opioid therapy was prescribed with increasing frequency over the past decade. However, factors surrounding long-term use of opioids in older adults remains poorly understood, probably because older people are not at the center stage of the national opioid crisis. OBJECTIVES: To estimate the annual utilization and trends in long-term opioid use among older adults in the United States. STUDY DESIGN: Retrospective cohort study. SETTING: Data from Medicare-enrolled older adults. METHODS: This study utilized a nationally representative sample of Medicare administrative claims data from the years 2012 to 2016 containing records of health care services for more than 2.3 million Medicare beneficiaries each year. Medicare beneficiaries who were 65 years of age or older and who were enrolled in Medicare Parts A, B, and D, but not Part C, for at least 10 months in a year were included in the study. We measured annual utilization and trends in new long-term opioid use episodes over 4 years (2013–2016). We examined claims records for the demographic characteristics of the eligible individuals and for the presence of chronic non-cancer pain (CNCP), cancer, and other comorbidities. RESULTS: From 2013 to 2016, administrative claims of approximately 2.3 million elderly Medicare beneficiaries were analyzed in each year with a majority of them being women (~56%) and white (~82%) with a mean age of approximately 75 years. The proportion of all eligible beneficiaries with at least one new opioid prescription increased from 6.64% in 2013, peaked at 10.32% in 2015, and then decreased to 8.14% in 2016. The proportion of individuals with long-term opioid use among those with a new opioid prescription was 12.40% in 2013 and 10.20% in 2016. Among new long-term opioid users, the proportion of beneficiaries with a cancer diagnosis during the study years increased from 13.30% in 2013 to 15.67% in 2016, and the proportion with CNCP decreased from 30.25% in 2013 to 27.36% in 2016. Across all years, long-term opioid use was consistently high in the Southern states followed by the Midwest region. LIMITATIONS: This study used Medicare fee-for-service administrative claims data to capture prescription fill patterns, which do not allow for the capture of individuals enrolled in Medicare Advantage plans, cash prescriptions, or for the evaluation of appropriateness of prescribing, or the actual use of medication. This study only examined long-term use episodes among patients who were defined as opioid-naive. Finally, estimates captured for 2016 could only utilize data from 9 months of the year to capture 90-day long-term-use episodes. CONCLUSIONS: Using a national sample of elderly Medicare beneficiaries, we observed that from 2013 to 2016 the use of new prescription opioids increased from 2013 to 2014 and peaked in 2015. The use of new long-term prescription opioids peaked in 2014 and started to decrease from 2015 and 2016. Future research needs to evaluate the impact of the changes in new and long-term prescription opioid use on population health outcomes. KEY WORDS: Long-term, opioids, older adults, trends, Medicare, chronic non-cancer pain, cancer, cohort study

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Effect of Preoperative Opioid Use on Adverse Outcomes, Medical Spending, and Persistent Opioid Use Following Elective Total Joint Arthroplasty in the United States: A Large Retrospective Cohort Study of Administrative Claims Data

Pain Medicine ◽

10.1093/pm/pnz083 ◽

2019 ◽

Vol 21 (3) ◽

pp. 521-531 ◽

Cited By ~ 20

Author(s):

Meridith Blevins Peratikos ◽

Hannah L Weeks ◽

Andrew J B Pisansky ◽

R Jason Yong ◽

Elizabeth Ann Stringer

Keyword(s):

Length Of Stay ◽

Claims Data ◽

The United States ◽

Adverse Outcomes ◽

Unplanned Readmission ◽

Administrative Claims ◽

Opioid Use ◽

Opioid Prescription ◽

Opioid Dose ◽

Opioid Users

Abstract Objective Between 17% and 40% of patients undergoing elective arthroplasty are preoperative opioid users. This US study analyzed patients in this population to illustrate the relationship between preoperative opioid use and adverse surgical outcomes. Design Retrospective study of administrative medical and pharmaceutical claims data. Subjects Adults (aged 18+) who received elective total knee, hip, or shoulder replacement in 2014–2015. Methods A patient was a preoperative opioid user if opioid prescription fills occurred in two periods: 1–30 and 31–90 days presurgery. Zero-truncated Poisson (incidence rate ratio [IRR]), logistic (odds ratio [OR]), Cox (hazard ratio [HR]), and quantile regressions modeled the effects of preoperative opioid use and opioid dose, adjusted for demographics, comorbidities, and utilization. Results Among 34,792 patients (38% hip, 58% knee, 4% shoulder), 6,043 (17.4%) were preoperative opioid users with a median morphine equivalent daily dose of 32 mg. Preoperative opioid users had increased length of stay (IRR = 1.03, 95% CI = 1.02 to 1.05), nonhome discharge (OR = 1.10, 95% CI = 1.00 to 1.21), and 30-day unplanned readmission (OR = 1.43, 95% CI = 1.17 to 1.74); experienced 35% higher surgical site infection (HR = 1.35, 95% CI = 1.14 to 1.59) and 44% higher surgical revision (HR = 1.44, 95% CI = 1.21 to 1.71); had a median $1,084 (95% CI = $833 to $1334) increase in medical spend during the 365 days after discharge; and had a 64% lower rate of opioid cessation (HR = 0.34, 95% CI = 0.33 to 0.35) compared with patients not filling two or more prescriptions across periods. Conclusions Preoperative opioid users had longer length of stay, increased revision rates, higher spend, and persistent opioid use, which worsened with dose. Adverse outcomes after elective joint replacement may be reduced if preoperative opioid risk is managed through increased monitoring or opioid cessation.

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SAFE AND EFFECTIVE PAIN CONTROL FOR GERIATRIC PATIENTS: A MULTIDISCIPLINARY APPROACH DURING THE OPIOID EPIDEMIC

Innovation in Aging ◽

10.1093/geroni/igz038.1490 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S401-S402

Author(s):

Tatyana Gurvich

Keyword(s):

Quality Of Life ◽

Pain Management ◽

Physical Therapy ◽

Integrative Medicine ◽

The United States ◽

Opioid Use ◽

Prescribing Practices ◽

Opioid Prescription ◽

Pain Medications

Abstract Opioid use is at a crisis level. According to the CDC, an estimated 20 % of patients presenting to physician offices with non-cancer pain receive an opioid prescription (1). According to the Administration on Aging and Substance Abuse and Mental Health Services Administration, the population of older adults who misuse opioids is expected to double by 2020. Today’s mandate to reduce opioid use and to manage patients safely with adjuvant medications comes with many challenges in geriatrics. Many patients have comorbidities which limit the use of adjuvant pain medications. A careful balance must be achieved, in order to provide good pain management and improve quality of life in this patient population. This symposium will explore multidisciplinary approaches to managing pain in geriatrics to reduce opioid use and manage safe opioid use where necessary. Pharmacological strategies for adjusting dosing and managing compliance will be discussed. Cooperative education to improve prescribing practices along with patient education to improve safe use, are important elements. Adjunct use of physical therapy and integrative medicine are also discussed as viable and effective adjuncts or alternatives to traditional pain management. You will learn how to use medications safely, utilize physical therapy to its maximum potential and learn more about innovative integrative medicine techniques, all of which decrease pain and improve function and most importantly quality of life. (1) Daubresse M, Chang HY, Yu Y, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 200-2010. Med Care 2013; 51:870-8

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Administration of and Prescribing Opioids in Emergency Departments: A Retrospective Study

Kansas Journal of Medicine ◽

10.17161/kjm.vol1413368 ◽

2021 ◽

Vol 14 ◽

pp. 1-4

Author(s):

Casey McNeil ◽

Alma Habib ◽

Hayrettin Okut ◽

Sheryl Beard ◽

Elizabeth Ablah ◽

...

Keyword(s):

Chronic Pain ◽

Drug Overdose ◽

Emergency Departments ◽

The United States ◽

Prescribing Practices ◽

Opioid Prescription ◽

Opioid Medication ◽

Opioid Prescribing ◽

Opioid Administration ◽

Overdose Deaths

Opioid overdose was a cause of 42,249 deaths in the United States in 2016 (13.3 deaths per 100,000) and contributed to 67.8% of all drug overdose deaths in the USA in 2017.1,2 The rate of drug overdose resulting in death in Kansas in 2016 was 11.8 per 100,000, (333 total drug overdose deaths).2 Emergency departments (EDs) are a key intermediary in opioid prescriptions. In 2010, 31% of ED visits nationally resulted in an opioid prescription.3 The number of opioid prescriptions from an ED varies greatly even for a single medical indication. For example, states varied from 40% to 2.8% of patients being prescribed an opioid medication from the ED for ankle sprains among opioid-naive patients treated from 2011 to 2015.4 In Kansas, 35.7% of ankle sprain patients received an opioid prescription from an ED.4 Guidelines for acute pain, including the Alternatives To Opioids protocol (ALTO)5 and the Center for Disease Control and Prevention’s Chronic Pain Guidelines (CDC-CPG)6 are available to guide opioid medication decisions. The ALTO protocol can be used to guide administration and prescription of analgesics for indications that include headache/migraine, musculoskeletal pain, renal colic, abdominal pain, bone fracture, and joint dislocation. The protocol encourages the use of analgesics such as acetaminophen, ibuprofen, and ketorolac prior to opioid administration.5 The CDC-CPG guides the provider into setting goals for pain control, discussing appropriate risks and benefits with the patients, and setting criteria for minimizing long-term opioid use,6 but defers to the American College of Emergency Physician’s 2012 clinical policy guideline for opioid management of chronic pain in the ED. The ACEP recommends against prescribing opioids for acute exacerbation of chronic pain in the ED [Level C recommendation].7 Adopting opioid prescribing guidelines has drastically reduced opioid prescribing rates in some locations.8 For example, a study performed in both a community and an academic medical center tested the implementation of an opioid prescribing guideline that resulted in a decline of opioid prescriptions from 52.7% to 29.8% of patient visits.8 Even in a hospital with less frequent opioid prescribing practices, adopting guidelines has reduced opioid administration in the ED from 22.5% to 17.7%.9 In 2017, 17 states had adopted opioid prescription guidelines10; however, Kansas is not one of those states. Knowing little of opioid prescribing practices in Wichita, Kansas, the purpose of this study was to identify factors that are associated with opioid administration and prescriptions in EDs in Wichita, Kansas, and to evaluate what methods are used by local prescribers to limit opioid administration and prescription in a locality without an opioid prescribing guideline.

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Opioid prescribing practices in adolescent and young adults with sarcomas.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.136 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 136-136

Author(s):

Melissa Beauchemin ◽

Rohit Raghunathan ◽

Melissa Kate Accordino ◽

Jason Dennis Wright ◽

Justine Kahn ◽

...

Keyword(s):

Young Adults ◽

Significant Proportion ◽

Opioid Use ◽

Prescribing Practices ◽

Opioid Prescription ◽

Opioid Prescribing ◽

Treatment Type ◽

Increased Risk ◽

History Of Use ◽

Post Therapy

136 Background: Adolescents and young adults (AYAs) with sarcoma undergo procedures that can result in acute and chronic pain. Adult cancer patients are at increased risk of chronic opioid use, and AYAs are vulnerable to misuse. However, opioid prescribing practices in AYAs with sarcoma are not known. We described opioid prescribing during active therapy and identify factors associated with continued opioid prescription post-treatment in AYAs with newly diagnosed sarcoma. Methods: Patients 10–26 years who were diagnosed with sarcoma between 2008–2016 were identified using IBM Marketscan database. Included subjects received anti-cancer therapy (chemotherapy, procedures, and/or radiation) within 30 days of diagnosis and were continuously enrolled in one insurance plan (commercial or Medicaid) >12-months both before diagnosis and after last therapy. Primary outcome was opioid use, defined as at least one opioid prescription during the 12 months following treatment completion. Covariates included age, sex, insurance, treatment type, mental health (MH) and substance use (SU) diagnoses. Results: We included 1,349 patients, 75% had commercial insurance, 21% had a previous MH, and 4% had previous SU diagnosis. 63% of subjects used opioids during treatment and 28% received at least 1 prescription in the year post-therapy. Medicaid insurance was associated with 60% higher likelihood of opioid use during treatment and those with prior use were three-times more likely to continue post- therapy. Conclusions: Opioid prescriptions in AYAs with sarcoma are common during treatment. A significant proportion of patients continue to receive opioids post-therapy, particularly those with a history of use pre-diagnosis. Medicaid insurance and MH disorder are also associated with continued use post-therapy. Further research is needed to establish safe and effective opioid prescribing practices in AYAs with sarcoma. [Table: see text]

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EXPLORINGTHE OPIOID PRESCRIBING PRACTICES OF GENERAL PRACTITIONERS (GPS) IN WEST AND SOUTH ESSEX, UK

International Journal of Advanced Research ◽

10.21474/ijar01/13123 ◽

2021 ◽

Vol 9 (07) ◽

pp. 245-257

Author(s):

Edwin Ugoh ◽

Vincent Icheku

Keyword(s):

Chronic Pain ◽

Pain Management ◽

General Practitioners ◽

Qualitative Data ◽

Prescription Medications ◽

Opioid Use ◽

Prescribing Practices ◽

Nominal Data ◽

Opioid Prescription ◽

Opioid Prescribing

Introduction:The emerging evidence in recent studies shows that Opioid use and abuse have continued to grow at a significant rate, with fatal consequences. The evidence also indicates palpable apprehension and concern over the increasing opiate/ opioid prescription numbers by General Practitioners (GPs). This present study aims to explore the opioid prescribing practices of General Practitioners (GPs) in West and South Essex. The objectives are to answer the following questions: is an opiate prescription based on any available guideline? Is opioid prescribed primarily for pain management? How many times do the GPs prescribe opioids? How long are patients on pain prescription medications? Has the GPs attended training on the use of opioid for pain management? How many years has the GPs spent working as a practitioner? Finally, these researchers believe that answers to these question will add to the knowledge base towards improving the risk-benefit balance of prescribed opiates. Methods:A short self-questionnaire was sent to all GP practices in the South and West of Essex (n=25). There was a response rate of 80 per cent (20/25). Qualitative data from the questions were analysed using thematic analysis. In addition, nominal data were analysed using descriptive statistics to summarise the results. Results:The study found that most of the GPs who participated in the survey are experienced GPs, yet the majority are not complying with prescribing guidelineand thus, overprescribes opioid for pain management. Conclusion:The overprescribing practices of opioids by GPs are affected by an absence of robust guideline on managing chronic pain. Thus, we recommendcompliance with existing guideline and consultation on managing chronic pain over 16s to producea guideline on adult pain management.

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Opioid Use Disorder: Screening, Diagnosis, and Management

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v16i2.425 ◽

2021 ◽

Vol 16 (2) ◽

pp. 25-30

Author(s):

Privia Randhawa ◽

Seonaid Nolan

Keyword(s):

Health Care ◽

Health Care Providers ◽

Opioid Use Disorder ◽

Care Providers ◽

Opioid Use ◽

Prescribing Practices ◽

Opioid Prescribing ◽

The Past ◽

Opioid Crisis ◽

Safe Opioid Prescribing

Over the past decade, the opioid crisis in Canada has been worsening. In 2019, over 3,800 people across Canada died due to an apparent opioid-related cause, which represents a 26% increase from just 3 years prior. Given North America’s ongoing opioid crisis, and the contribution opioid-prescribing practices have had to date, a critical need exists to ensure that health care providers are not only educated about safe opioid prescribing but also are knowledgeable about how to effectively screen for, diagnose, and treat an individual with opioid use disorder. RésuméAu cours des dix dernières années, la crise des opioïdes au Canada n’a cessé de s’aggraver. En 2019, plus de 3 800 personnes au Canada sont décédées d’une cause apparemment liée à la consommation d’opioïdes, ce qui représente une augmentation de 26 % par rapport à seulement trois ans auparavant. Étant donné la crise des opioïdes qui sévit actuellement en Amérique du Nord et la contribution des pratiques de prescription d’opioïdes qui ont eu cours jusqu’ici, un besoin critique est à combler pour veiller à ce que les fournisseurs de soins soient non seulement formés sur la prescription sécuritaire des opioïdes, mais aussi bien informés sur le dépistage, le diagnostic et le traitement efficace d’un trouble lié à la consommation d’opioïdes.

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US Trends in Opioid Access Among Patients With Poor Prognosis Cancer Near the End-of-Life

Journal of Clinical Oncology ◽

10.1200/jco.21.00476 ◽

2021 ◽

pp. JCO.21.00476

Author(s):

Andrea C. Enzinger ◽

Kaushik Ghosh ◽

Nancy L. Keating ◽

David M. Cutler ◽

Mary Beth Landrum ◽

...

Keyword(s):

End Of Life ◽

Poor Prognosis ◽

The United States ◽

Sensitivity Analyses ◽

Administrative Claims ◽

Fee For Service ◽

Opioid Use ◽

Opioid Prescription ◽

Ed Visits ◽

Long Acting

PURPOSE Heightened regulations have decreased opioid prescribing across the United States, yet little is known about trends in opioid access among patients dying of cancer. METHODS Among 270,632 Medicare fee-for-service decedents with poor prognosis cancers, we used part D data to examine trends from 2007 to 2017 in opioid prescription fills and opioid potency (morphine milligram equivalents per day [MMED]) near the end-of-life (EOL), defined as the 30 days before death or hospice enrollment. We used administrative claims to evaluate trends in pain-related emergency department (ED) visits near EOL. RESULTS Between 2007 and 2017, the proportion of decedents with poor prognosis cancers receiving ≥ 1 opioid prescription near EOL declined 15.5% (relative percent difference [RPD]), from 42.0% (95% CI, 41.4 to 42.7) to 35.5% (95% CI, 34.9 to 36.0) and the proportion receiving ≥ 1 long-acting opioid prescription declined 36.5% (RPD), from 18.1% (95% CI, 17.6 to 18.6) to 11.5% (95% CI, 11.1 to 11.9). Among decedents receiving opioids near EOL, the mean daily dose fell 24.5%, from 85.6 MMED (95% CI, 82.9 to 88.3) to 64.6 (95% CI, 62.7 to 66.6) MMED. Overall, the total amount of opioids prescribed per decedent near EOL (averaged across those who did and did not receive an opioid) fell 38.0%, from 1,075 morphine milligram equivalents per decedent (95% CI, 1,042 to 1,109) to 666 morphine milligram equivalents per decedent (95% CI, 646 to 686). Simultaneously, the proportion of patients with pain-related ED visits increased 50.8% (RPD), from 13.2% (95% CI, 12.7 to 13.6) to 19.9% (95% CI, 19.4 to 20.4). Sensitivity analyses demonstrated similar declines in opioid utilization in the 60 and 90 days before death or hospice, and suggested that trends in opioid access were not confounded by secular trends in hospice utilization. CONCLUSION Opioid use among patients dying of cancer has declined substantially from 2007 to 2017. Rising pain-related ED visits suggests that EOL cancer pain management may be worsening.

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The Effects of the Opioid Epidemic on Prescribing Practices in Long-Term Care Residents

The Senior Care Pharmacist ◽

10.4140/tcp.n.2019.258 ◽

2019 ◽

Vol 34 (4) ◽

pp. 258-267

Author(s):

Lisa Yamagishi ◽

Olivia Erickson ◽

Kelly Mazzei ◽

Christine O'Neil ◽

Khalid M. Kamal

Keyword(s):

Severe Pain ◽

Long Term Care ◽

Care Facility ◽

The United States ◽

Self Report ◽

Prescribing Practices ◽

Term Care ◽

Data Set ◽

Opioid Prescribing

OBJECTIVE: Evaluate opioid prescribing practices for older adults since the opioid crisis in the United States. DESIGN: Interrupted time-series analysis on retrospective observational cohort study. SETTING: 176-bed skilled-nursing facility (SNF). PARTICIPANTS: Patients admitted to a long-term care facility with pain-related diagnoses between October 1, 2015, and March 31, 2017, were included. Residents discharged prior to 14 days were excluded. Of 392 residents, 258 met inclusion criteria with 313 admissions. MAIN OUTCOME MEASURE: Changes in opioid prescribing frequency between two periods: Q1 to Q3 (Spring 2016) and Q4 to Q6 for pre- and postgovernment countermeasure, respectively. RESULTS: Opioid prescriptions for patients with pain-related diagnoses decreased during period one at -0.10% per quarter (95% confidence interval [CI] -0.85-0.85; P = 0.99), with the rate of decline increasing at -3.8% per quarter from period 1 and 2 (95% CI -0.23-0.15; P = 0.64). Opioid prescribing from top International Classification of Diseases, Ninth Revision category, "Injury and Poisoning" decreased in prescribing frequency by -3.0% per quarter from Q1 to Q6 (95% CI -0.16-0.10; P = 0.54). Appropriateness of pain-control was obtained from the Minimum Data Set version 3.0 "Percent of Residents Who Self-Report Moderate to Severe Pain (Short Stay)" measure; these results showed a significant increase in inadequacy of pain relief by 0.28% per quarter (95% CI 0.12-0.44; P = 0.009). CONCLUSION: Residents who self-report moderate- to severe pain have significantly increased since October 2015. Opioid prescriptions may have decreased for elderly patients in SNFs since Spring 2016. Further investigation with a larger population and wider time frame is warranted to further evaluate significance.

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