SCPC Urges CDC to Exempt Long-Term Care Patients from Opioid Guidelines

DATE: June 18, 2020

Given the unique medical needs of patients in long-term care facilities and the virtual impossibility of “doctor-shopping,” the CDC’s Opioid Guidelines must not apply to this unique population

Washington, DC – Today the Senior Care Pharmacy Coalition (SCPC) announced that it submitted a letter to the Centers for Disease Control and Prevention (CDC) urging the agency to consider the unique needs of patients in long-term care (LTC) facilities when crafting the next modification of the CDC’s Opioid Guidelines.

In a letter addressed to Director Dr. Robert Redfield, SCPC asked the CDC to include a specific statement in the Opioid Guidelines to clarify that any recommended opioid limits do not apply to patients in long-term care facilities, including skilled nursing facilities, nursing facilities, and assisted living facilities. While SCPC shares the CDC’s concern about the threat prescription drug abuse poses to Americans across the country and agrees there is a real need to ensure Americans do not abuse opioids and other prescription medications, it urged the CDC to consider the unique needs of seniors in these facilities.

Specifically, SCPC pointed out that patients in LTC settings pose a very low risk of abusing opioids or other prescription medications due to the closed nature of the distribution system in LTC facilities and the extensive clinical responsibilities and medication monitoring requirements imposed on LTC pharmacies. The risk of opioid abuse or misuse is further decreased by the strict packaging and delivery requirements that the nation’s LTC pharmacies satisfy every day. Additionally, LTC pharmacies meet extensive and extended clinical responsibilities they have to patients, including reconciling opioids and controlled substances at least daily and organizing drug utilization review (DUR) once a month at a minimum.

As LTC patients are more medically complex than the general population, have a higher incidence of pain requiring drug treatment, more conditions contraindicating alternatives to opioids for pain management, and higher incidence of breakthrough pain requiring larger doses of pain management medication, it is critical that their care not be impeded by potentially restrictive guidelines. The average patient in a LTC facility is in their mid-80s, suffering from multiple chronic conditions and taking, on average, 12 prescription medications. As SCPC notes in the letter, “there is virtually no possibility that these patients could ‘doctor shop’ or ‘pharmacy shop’ to support either addiction or diversion.”

Recognizing all of these factors, SCPC has asked the CDC to include a specific statement that any recommended opioid limits not apply to patients in long-term care facilities, including skilled nursing facilities, nursing facilities and assisted living facilities.

“We urge the CDC to recognize the distinct factors that impact appropriate use and dosage of opioids in the LTC patient population by revising existing Guidelines to explicitly exempt all LTC facilities – (SNFs, NFs, and ALFs),” the letter said. “We also recommend that the CDC recognize the distinct characteristics of the LTC patient population and the substantial protections against substance abuse that LTC pharmacies provide when considering future guidelines, recommendations and policies.”

To read the letter SCPC submitted to the CDC, click here.

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The Senior Care Pharmacy Coalition (SCPC) is the only national organization exclusively representing the interests of LTC pharmacies. Its members operate in all 50 states and serve 850,000 patients daily in skilled nursing and assisted living facilities across the country. Visit to learn more.

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