A high-dose painkiller prescription often accompanies hospital patients when they are discharged to skilled nursing facilities, according to a new study. The results paint a complex medication picture for many older adults, investigators say.

The researchers tracked data from more than 4,300 study participants. Fully 70% received an opioid prescription upon hospital discharge, and 68% of those prescriptions were for oxycodone, reported Jon Furuno, Ph.D., of the University of Oregon. Among participants who received an opioid prescription, 61% were age 65 and older. 

Oxycodone is 1.5 times as potent as morphine. More than half of the opioid prescriptions in the study had a daily morphine milligram equivalent of 90 and higher, increasing the risk for opioid-related harm, Furuno and colleagues found.

Not surprisingly, patients transferred to nursing facilities with high-dose pain prescriptions were more likely to share certain health histories tied to pain. These included having undergone surgery and having a diagnosis of cancer or chronic pain. These factors — in addition to being female and receiving an opioid the day of hospital admission — each were independently associated with the chances of receiving an opioid prescription upon discharge to skilled nursing care.

The findings reveal the challenges of prescribing pain-killing medication for these patients, Furuno said. Providers must juggle interactions with multiple drugs and the risks added by frailty and cognitive impairment. In addition, skilled nursing facility residents often are undertreated for pain, he noted. 

“These results support the complexity and need to optimize opioid prescribing in this patient population,” he concluded.

The study was published in Pharmacoepidemiology and Drug Safety.