Design: Cross-sectional study of national MDS 3.0 and Part D data
Population: 135,347 long-stay US nursing home residents (2019)
Primary outcome: Prevalence of opioid use and co-use with potentiators
Effect: 24.0% on opioids; 52.0% of these also on a potentiator

This cross-sectional study linked 2019 US Minimum Data Set assessments with Part D prescription claims for 135,347 long-stay nursing home residents.

One in four (24.0%) had an opioid prescription in the 120 days after assessment: 7.1% short-term, 5.5% medium-term and 11.4% long-term users. Among opioid users, 52.0% also had an opioid potentiator — most often a gabapentinoid, then a benzodiazepine or Z-drug. Pain and anxiety were associated with use. Residents with cognitive impairment or dementia were less likely to receive opioids, which may reflect under-recognised pain as much as caution.

The data are cross-sectional and do not measure harm, though co-use is known to raise risks of sedation, falls and respiratory depression.

For anyone reviewing medicines in care homes, the combination of an opioid with a gabapentinoid or sedative is a clear and frequent target.

About 1 in 4 long-stay residents had an opioid; 1 in 9 were long-term users.
Half of opioid users also took a gabapentinoid, benzodiazepine or Z-drug.
Review every resident on an opioid for a co-prescribed potentiator.
Consider non-opioid analgesia and physiotherapy before escalating opioids.
Assess pain actively in residents with dementia, who received fewer opioids.

Why it matters

Gabapentinoids are often added for pain without being counted as a sedative risk alongside the opioid.

The statistics, in plain English

These are prevalence figures from a national sample, so they describe how common the pattern is. They cannot show harm in these residents, which earlier studies have linked to such combinations.