While nursing homes routinely review antipsychotics, opioids often receive less attention—even though they pose similar or greater risks. Oversight should be standard, especially for older adults and residents with a history of substance or alcohol use disorders.

Why Opioid Reviews Matter
High-risk population: Older adults are vulnerable to sedation, falls, cognitive impairment, and respiratory depression.
Opioid crisis: Vulnerable populations remain disproportionately affected, making opioid stewardship critical.
Regulatory expectations: Federal guidance emphasizes tapering unnecessary or harmful opioid use.

A Resident Story
A nursing home resident started opioids three months ago after shoulder arthroplasty. When she returned to the hospital for pneumonia, the medication was resumed as a routine home medication. Back in the nursing home, staff noticed sleepiness, difficulty in therapy, and several near-falls. With pharmacy input, PRN review, and gradual tapering similar to antipsychotic reduction strategies, she regained alertness, participated in therapy again, and her fall risk decreased.

Regulatory Spotlight
F‑Tag F697 – Pain Management: Safe, resident-centered pain care; caution with opioids, including combination with benzodiazepines; use reversal strategies like naloxone.
F‑Tag F757 – Unnecessary Drug Review: Ensure drug regimens are free from unnecessary medications, excessive doses, or use without indication; regular medication review is essential.

What Facilities Should Do

1. Include opioids in quality reviews, including PRN use, with pharmacy input.
2. Evaluate deprescribing opportunities based on dose, side effects, efficacy, and risk factors.
3. Taper thoughtfully, avoid abrupt discontinuation.
4. Document taper plans with monitoring and alternative pain approaches.
5. Train staff to recognize oversedation, misuse, and withdrawal.

Bottom Line
Opioids deserve the same rigor as psychotropics. Regular review, PRN evaluation, tapering, and interdisciplinary collaboration, guided by F‑697 and F‑757—protect residents, improve well-being, and support safe, high-quality care.