A team of researchers at the University of Missouri-Kanas City School of Pharmacy is taking a close look at prescribing trends for opioids used as pain management medications for older residents in nursing homes. Moreover, they are exploring how often opioids are being prescribed in combination with other medications to reduce pain.

Maureen Knell, Pharm.D., a clinical professor at UMKC and clinical pharmacist at Saint Luke’s Health System Medical Education Internal Medicine Clinic, says the teams is particularly looking at how opioids are being used in nursing homes in conjunction with other medications that can impact the central nervous system.

Prescribing multiple medications on top of opioids can have a significant effect on older adults and create an increased risk for adverse events ranging from falls to constipation to affecting cognitive function.

“These are things that we are concerned about and watch out for in our practice every day,” Knell said.

With data collected from four long-term care facilities in Missouri, Mark Patterson, Ph.D., M.P.H., associate professor of pharmacy, has created a registry of more than 1,800 medications and supplements to track medication discrepancy during transitions of care among 126 nursing home residents. It can be used to characterize prescribing patterns among various subsets of patients with different diseases and different medications.

Working with Knell and fellow researchers Melissa Palmer, Pharm.D., clinical assistant professor, and Kaylee Huffman, a third-year UMKC pharmacy student, Patterson is looking not only at the types of opioids being prescribed, but also additional medications that are sometimes prescribed at the same time to treat pain or other comorbidities.

One overarching concern, he said, is the concept of polypharmacy in which patients are being prescribed more than five different medications at the same time, sometimes for the same condition.

“When that happens in an older group of patients who are also on opioids, that's a very high-risk mixture going on,” Patterson said. “So, we are very interested in looking further into the trends with regards to this high-risk population.” 

Knell said finding patients on multiple drugs that affect their central nervous system such as antidepressants, antipsychotics or antianxiety medications such as valium and diazepam on top of opioids for pain management particularly raises a red flag.

“Those types of agents combined with opioids, that's something that the guidelines are pretty clear on, that those increase the risk of undesirable effects when you combine them with opioids,” she said.

Another concern that Patterson brings up is transition of care, when older adults go back and forth between hospital and the nursing home. When older patients are seen by multiple care providers, it creates a complicated dynamic in light of those patients receiving multiple prescribed medications. 

 “We are seeing potentially dangerous combinations of medications being prescribed,” Patterson said. “We don’t know yet the exact number or the rates, but it is concerning.”

The information the UMKC research team is gathering will be a potentially valuable tool for the vast array of health professionals involved in providing care for older adults. In addition to the staff of nurses, physicians and pharmacists in the nursing homes, those in hospitals and individual primary care physicians all have hand in managing the residents’ medications as well as the community pharmacists supplying them.

“It’s important that all health care providers, patients and caregivers appreciate and understand the significance and implications of these prescribing trends,” Patterson said. “Especially with older adults residing in nursing homes or discharged from hospitals who are prescribed opioids.”

Looking forward, Knell said data outlining the prescribing trends of opioids in conjunction with adjuvant, non-opioid medications will hopefully help policy makers and individual clinicians make better decisions on how different medication go together or even whether they should be used together. It could also potentially be applied to a broader range of adults or other special populations.

“I think there are a broad range of possibilities with this,” she said.