- Design
- Interrupted time series of a nationally representative cohort, 2010-2022
- Population
- 3,246 community-dwelling US adults aged 65 or over with dementia
- Primary outcome
- Quarterly opioid and gabapentinoid prescribing rates
- Effect
- Tramadol down 27.1% (guideline-associated); gabapentinoids 9.5% to 11.5%
A JGIM interrupted time series, published on 20 October 2026, followed 3,246 community-dwelling US adults aged 65 or over with dementia, median age about 81, through Medicare survey and claims data from 2010 to 2022.
Prescribing of conventional opioids fell 26.5% over the period, but the 2016 CDC guideline was not associated with a change in that decline. Tramadol prescribing fell 27.1% and that fall was associated with the guideline. Gabapentinoid prescribing rose from 9.5% to 11.5% with no change in trend after 2016. Buprenorphine use stayed near zero.
The pattern suggests substitution rather than a simple reduction in analgesic exposure. Gabapentinoids carry their own risks of sedation, falls and confusion in people with dementia, and the study cannot say whether pain was better or worse controlled.
- Review the indication for any gabapentinoid in a patient with dementia, particularly after a fall or delirium.
- Assess pain with an observational tool when a patient with dementia cannot self-report.
- Consider regular paracetamol first for persistent pain in older adults with dementia.
- Check for combined opioid and gabapentinoid prescribing, which adds sedative burden.
Why it matters
Swapping one sedating analgesic for another is not deprescribing, and the patient may be no better off.
Don't overread it
Prescribing trends only — it cannot show whether pain control or harms changed.
The statistics, in plain English
An interrupted time series compares the trend before and after an event. For conventional opioids, the confidence intervals around the change crossed zero, so the guideline cannot be credited with the decline.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for internal medicine, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free