Nursing Home Patients May Need More Opiates

Should guidelines on prescribing narcotic painkillers be different when it comes to patients—usually elderly—in long-term care facilities?

At today’s meeting of the American Medical Association’s House of Delegates in Chicago, IL,, physicians debating a proposal to loosen restrictions on opioids for these patients were of two minds.

Advocates for making it easier for doctors caring for these patients pointed out that while there are always risks of patients getting addicted to opioids, as well as incurring side effects, opioids may be necessary to prevent the bleeding risks that come with non-steroidal anti-inflammatory drugs (NSAIDS.)

“NSAIDS have a bleeding risk and the trouble with guidelines is that they are taking place of clinical judgment,” said one advocate endorsing a resolution to give nursing home physicians more leeway it prescribing opiates.

If physician judgment is not allowed to be part of the decision-making process, “You might as well let a computer do it—narcotics are sometimes needed,” he said.

Opposed were physicians who said that opioids aren’t any safer for the elderly than for anyone else, and that they can put these patients at higher risk of falling, developing bowel obstructions, and even cardio-vascular disease.

“The CDC guidelines are already very appropriate for these patients,” said a Kentucky delegate opposed to adopting a nursing home leniency resolution, “I’ve seen a lot of elderly using opioids inappropriately and I’ve weaned them—nursing homes should not be less regulated,” he said.

A Wisconsin delegate disagreed, saying that patients in palliative care and hospice care fall under different guidelines for opiate use. “Similarly, patients in long-term care settings need to be treated differently too,” he said.