Opioid Prescribing Patterns in Skilled Nursing Facilities

The Medicare population has one of the highest and fastest-growing rates of diagnosed opioid use disorder. With approximately 20% of hospitalized Medicare beneficiaries being discharged to skilled nursing facilities (SNFs), licensed health professionals working in SNFs are providing pain management to beneficiaries who are just starting on opioids as part of post-surgical pain management and to beneficiaries with chronic pain who may have developed dependence on opioids.

While opioid prescribing patterns have been well-described in both the hospital and primary care settings, little is known about opioid prescribing in SNFs. This study will describe opioid prescribing patterns by clinician specialty in SNFs, including quantity and dose dispensed, associations of provider specialties with opioids at admission and discharge and trends between 2015-2017.

Using descriptive and regression analyses, researchers will examine how opioid prescribing patterns differ for different clinician types. In addition, the study will use 100% Medicare SNF claims in conjunction with the CMS National Plan and Provider Enumeration System data (NPPES), which provides taxonomy codes and a crosswalk to the national provider identifiers in the Medicare data. This will permit us to identify not only physician subspecialties but also nurse practitioner subspecialties.

Results will identify variation in the prescribing of opioids within nursing homes in the United States, while also providing helpful information to identify opportunities to enrich the training of nursing home physicians and staff in pain management.


Key Questions

  • What are the opioid prescribing patterns by provider specialty in SNFs, including average number of prescriptions and days supplied?
  • What are the trends in opioid prescribing patterns by provider specialty in SNFs between 2015-2017? Building on the results of the first research question, researchers will identify any trends for specific specialties.
  • Are specific provider specialties associated with the first opioid prescription after admission?
  • Are specific provider specialties associated with opioid prescriptions at discharge?
  • Are specific provider specialties associated with successful discontinuation of opioids during the beneficiaries’ SNF stays?
  • What are the patient characteristics associated with opioid prescriptions in SNFs, including diagnoses, length of stay, rural/urban residence, and nurse practitioner scope of practice regulations?

For questions, contact: Ulrike Muench.



Muench, U, Jura, M, Samson, S, Monroe, T, Spetz, J. Prescribing Patterns in Nursing Home Residents Living with Dementia by Specialty and Provider Type. Available online May, 2022.