Comparison of opioid use among long-term care residents in Ontario and Alberta, Canada: A multi-jurisdictional, repeated cross-sectional study.

Background: Exploring regional variation in opioid use for pain among long-term care (LTC) residents may help identify modifiable factors associated with suboptimal prescribing practices. Aims: We aimed to compare recent trends in prevalent opioid use and higher risk prescribing among LTC residents in Ontario and Alberta, and to examine variation in opioid trends across resident subgroups within each province. Methods: Utilizing comparable linked clinical and health administrative databases for LTC residents (aged >65) in each province, we examined trends in monthly use of any opioid, specific drug types and formulations, high daily doses (≥90 Morphine Equivalents), and concurrent use with a benzodiazepine or gabapentinoid. Prevalence ratios comparing change in opioid measures, overall and across resident subgroups, from the first (March 2015) to last study (March 2022) months were estimated using age-sex adjusted log-binomial regression models. Results: Opioid prevalence (any, select types, long-acting formulations, high daily doses) was consistently higher among Ontario residents whereas concurrent use with a benzodiazepine or gabapentinoid was higher among Alberta residents. Overall use remained stable in Ontario but increased by 23% in Alberta LTC. In both provinces, there were significant decreases in higher risk opioid prescribing over time, including concurrent use with benzodiazepines, but also significant increases in the concurrent use with gabapentinoids and tramadol use (Alberta only). Conclusions: Although both provinces showed trends toward more appropriate opioid use in LTC, the factors driving observed provincial differences in opioid prescribing and the rise in concurrent opioid and gabapentinoid use among residents, warrant further investigation.