NATIONAL TRENDS IN OPIOID, BENZODIAZEPINE AND ANTICHOLINERGIC ORDERS IN LONG-TERM CARE
Author(s)
Kate Mathers, PhD1, Tyler Saumur, PhD1, Jody Long, MSN, MBA, RN, CEN2, Steve Buslovich, MD2;
1PointClickCare Life Sciences, Mississauga, ON, Canada, 2PointClickCare, South Jordan, UT, USA
1PointClickCare Life Sciences, Mississauga, ON, Canada, 2PointClickCare, South Jordan, UT, USA
OBJECTIVES: The Centers for Medicare and Medicaid Services added 2 new quality measures that will impact 2027 Star Ratings: 1) Concurrent Use of Opioids and Benzodiazepines and 2) Polypharmacy Use of Multiple Anticholinergic Medications in Older Adults. The purpose of this study was to use electronic health record data to describe concurrent use of opioids and benzodiazepines (OB use) and use of ≥2 unique anticholinergic medications (ACH use) among long-term care residents in the United States.
METHODS: Electronic health record data from 4,840,452 residents between 01 Jan 2022 and 31 Mar 2025 was assessed for opioid, benzodiazepine, and anticholinergic medication order data. Medication order counts, duration, and top combinations were reported. Geographic trends in medication orders were also explored.
RESULTS: There were 657,915 (13.6%) residents with OB use and 333,264 (6.9%) residents with ACH use, with 215,266 (4.4%) and 135,619 (2.8%) with concurrent orders for ≥30 days, respectively. Mean opioid order durations were 58.4 days (opioids), 36.4 days (benzodiazepines), and 76.3 days (anticholinergics). The most common drugs ordered for the 657,915 residents with OB use were lorazepam (66.4%) and morphine (47.0%), which was the most common medication combination (28.5%). The most common orders for the 333,264 residents with ACH use were hydroxyzine (29.1%), diphenhydramine (23.6%), and oxybutynin (20.8%). The states with the highest proportion of residents with ≥30 days of OB use were Nebraska (9.5%), South Dakota (9.0%), and Arkansas (8.5%). The states with the highest proportion of residents with ≥30 days of ACH use were Mississippi (4.2%), Oklahoma (4.2%), and Louisiana (3.1%).
CONCLUSIONS: High-risk prescribing and significant geographic variation underscore the need for accurate documentation, targeted deprescribing, and monitoring. Leveraging regional data enables focused quality improvement and resource allocation. Proactive, data-driven strategies tailored to local trends are critical for safer medication management and achieving Star Ratings success.
METHODS: Electronic health record data from 4,840,452 residents between 01 Jan 2022 and 31 Mar 2025 was assessed for opioid, benzodiazepine, and anticholinergic medication order data. Medication order counts, duration, and top combinations were reported. Geographic trends in medication orders were also explored.
RESULTS: There were 657,915 (13.6%) residents with OB use and 333,264 (6.9%) residents with ACH use, with 215,266 (4.4%) and 135,619 (2.8%) with concurrent orders for ≥30 days, respectively. Mean opioid order durations were 58.4 days (opioids), 36.4 days (benzodiazepines), and 76.3 days (anticholinergics). The most common drugs ordered for the 657,915 residents with OB use were lorazepam (66.4%) and morphine (47.0%), which was the most common medication combination (28.5%). The most common orders for the 333,264 residents with ACH use were hydroxyzine (29.1%), diphenhydramine (23.6%), and oxybutynin (20.8%). The states with the highest proportion of residents with ≥30 days of OB use were Nebraska (9.5%), South Dakota (9.0%), and Arkansas (8.5%). The states with the highest proportion of residents with ≥30 days of ACH use were Mississippi (4.2%), Oklahoma (4.2%), and Louisiana (3.1%).
CONCLUSIONS: High-risk prescribing and significant geographic variation underscore the need for accurate documentation, targeted deprescribing, and monitoring. Leveraging regional data enables focused quality improvement and resource allocation. Proactive, data-driven strategies tailored to local trends are critical for safer medication management and achieving Star Ratings success.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH137
Topic
Epidemiology & Public Health
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
SDC: Geriatrics