ArticleJournal of the American Medical Directors Association2026
Geographic Variation of Gabapentinoids and Opioids in US Nursing Homes.
Article in Journal of the American Medical Directors Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo examine and quantify geographic variation in gabapentinoids, opioids, and their concurrent use among long-stay nursing home residents in the United States.
designCross-sectional study. SETTING AND
participantsA total of 232,484 long-stay residents aged ≥65 years in 9741 US nursing homes across 300 hospital referral regions (HRRs) in 2021.
methodsWe used Minimum Data Set 3.0 linked to Medicare Parts A and D claims, facility characteristics, and HRR data. Outcomes were gabapentinoid-only use, opioid-only use, and concurrent use. Residents were classified by nursing home state and HRR. Cross-classified multilevel logistic regression models quantified between-HRR and between-state variation. Sequential models estimated the proportional change in variance after adjustment for resident, facility, and HRR characteristics.
resultsThe prevalence of gabapentinoid-only use was 13.4%, opioid-only use was 9.1%, and concurrent use was 5.4%. Geographic variation was substantial, particularly for opioid-only and concurrent use. For opioid-only use, resident characteristics explained 39.1% of HRR-level and 35.3% of state-level variation, with 61.2% and 60.8% explained in fully adjusted models. For concurrent use, resident characteristics explained most variation, accounting for 64.3% of HRR-level and 52.1% of state-level variation, with 65.4% and 62.2% explained after full adjustment. In contrast, gabapentinoid-only use showed smaller geographic variation, with facility characteristics explaining more HRR-level variance than resident factors. CONCLUSIONS AND IMPLICATIONS: Geographic variation exists in gabapentinoids, opioids, and their concurrent use in US nursing homes. Variation in opioid-only and concurrent use largely reflects resident characteristics, whereas gabapentinoid use appears more influenced by facility and regional factors, suggesting differences in prescribing practices beyond clinical need.
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