As the United States continues to recover from the devastating opioid epidemic, new research from the University of California, San Francisco (UCSF) shows that the nationwide effort to curb opioid prescriptions has had unintended consequences—especially for older adults living in nursing homes who rely on these medications to manage chronic pain.
The study, published in JAMA Internal Medicine, analyzed data from nearly 3 million nursing home residents between 2011 and 2022.
Researchers found that the likelihood of receiving an opioid prescription dropped significantly over that period—from about 48% to 33.5%.
The decline occurred across all groups, even among residents with severe, persistent pain.
This marks the first study to examine long-term opioid prescribing trends in nursing homes and to explore how they differ by race, ethnicity, and pain level.
The researchers used data from the Centers for Medicare & Medicaid Services (CMS) to understand how policies shaped medical decisions for some of the most vulnerable patients.
The shift began after the Centers for Disease Control and Prevention (CDC) issued opioid prescribing guidelines in 2016 aimed at reducing overprescription in outpatient settings.
While the goal was to prevent addiction and overdose, the new research shows these guidelines may have rippled into nursing homes—settings where misuse is rare, but pain is common.
“Older adults in nursing homes really shouldn’t be as impacted by the CDC opioid guidelines,” said Dr. Ulrike Muench, the study’s first author and associate professor in the UCSF School of Nursing.
“Chronic pain is very common among nursing home residents because they often have multiple medical conditions. These are not the patients at high risk for opioid misuse.”
The findings also revealed racial and ethnic disparities in pain management. Black, Hispanic, Asian, and American Indian or Alaska Native residents were consistently less likely than white residents to receive opioid prescriptions—even when reporting severe pain. They were also less likely to receive higher doses.
“It really surprised us that even when people reported having very severe chronic pain, white nursing home residents were more likely to receive opioids—and at higher doses,” Dr. Muench said.
While the researchers support efforts to reduce unnecessary opioid use, they warn that this broad decline could leave many nursing home residents suffering needlessly. Effective pain management, they stress, is vital for healthy aging and maintaining dignity and quality of life in long-term care.
The study’s authors hope their findings will spark more balanced policies—ones that continue to curb dangerous overprescribing but also ensure that older adults in pain get the relief they need.
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