Greater Opioid Use Among Nursing Home Residents in Ontario, Canada During the First 2 Waves of the COVID-19 Pandemic

doi:10.1016/j.jamda.2022.02.011

Journal of the American Medical Directors Association

Volume 23, Issue 6, June 2022, Pages 936-941

https://doi.org/10.1016/j.jamda.2022.02.011 Get rights and content

Abstract

Objectives

To examine the association between the COVID-19 pandemic and opioid use among nursing home residents followed up to March 2021, and possible variation by dementia and frailty status.

Design

Population-based cohort study with an interrupted time series analysis.

Setting and Participants

Linked health administrative databases for residents of all nursing homes (n = 630) in Ontario, Canada were examined. Residents were divided into consecutive weekly cohorts (first observation week was March 5 to 11, 2017 and last was March 21 to March 27, 2021).

Methods

The weekly proportion of residents dispensed an opioid was examined overall and by strata defined by the presence of dementia and frailty. Autoregressive Integrated Moving Average models with step and ramp intervention functions tested for immediate level and slope changes in weekly opioid use after the onset of the pandemic (March 1, 2020) and were fit on prepandemic data for projected trends.

Results

The average weekly cohort ranged from 76,834 residents (prepandemic) to 69,359 (pandemic period), with a consistent distribution by sex (69% female) and age (54% age 85 + years). There was a statistically significant increased slope change in the weekly proportion of residents dispensed opioids (parameter estimate (β) = 0.035; standard error (SE) = 0.005, P < .001). Although significant for all 4 strata, the increased slope change was more pronounced among nonfrail residents (β = 0.038; SE = 0.008, P < .001) and those without dementia (β = 0.044; SE = 0.008, P < .001). The absolute difference in observed vs predicted opioid use in the last week of the pandemic period ranged from 1.25% (frail residents) to 2.28% (residents without dementia).

Conclusions and Implications

Among Ontario nursing home residents, there was a statistically significant increase in opioid dispensations following the onset of the pandemic that persisted up to 1 year later. Investigations of the reasons for increased use, potential for long-term use and associated health consequences for residents are warranted.

Keywords

COVID-19

opioid use

nursing home

time-series analysis

Cited by (0)

: This research was funded by the CIHR through operating grant (#PJT 168914, Understanding and optimizing opioid use in long term care), by ICES through an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-term Care (MLTC) and with support from the Ontario Health Data Platform (OHDP), a Province of Ontario initiative to support Ontario's ongoing response to COVID-19 and its related impacts.

: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

: The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by the ICES, the MOH or MLTC, the OHDP, its partners, or the Province of Ontario is intended or should be inferred. Parts of this material are based on data and information compiled and provided by CIHI; however, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of CIHI.

: CM and SB reported receiving grants from the Canadian Institutes of Health Research (CIHR), Canada, and nonfinancial support from ICES, Canada (formerly Institute for Clinical Evaluative Sciences). Authors have no other conflicts of interest to disclose.

: The data set from this study is held securely in coded form at ICES. Although data sharing agreements prohibit ICES from making the data set publicly available, access may be granted to those who meet prespecified criteria for confidential access at https://www.ices.on.ca/DAS. Please contact the authors for any supplemental information related to the study such as the study protocol, analysis plan, or analytic code. The full data set creation plan and underlying analytic code are available from the authors upon request, understanding that the computer programs may rely on coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.

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