DECEMBER 5, 2025
New research suggests multimodal opioid-containing regimens, including a gabapentin regimen, were commonly prescribed for older adults in need of pain medications following a hip fracture at skilled nursing facilities (SNF). Longitudinal pain medication use among older adults after a hip fracture.
“We found that about 90% of patients taking gabapentin were also taking an opioid at the same time,” Kaley Hayes, the associate director of pharmacoepidemiology at the Brown
New research suggests multimodal opioid-containing regimens, including a gabapentin regimen, were commonly prescribed for older adults in need of pain medications following a hip fracture at skilled nursing facilities (SNF). Longitudinal pain medication use among older adults after a hip fracture.
“We found that about 90% of patients taking gabapentin were also taking an opioid at the same time,” Kaley Hayes, the associate director of pharmacoepidemiology at the Brown University Center for Gerontology and Healthcare Research, in Providence, Rhode Island, said in a statement. “That’s concerning because this combination can increase the risk of respiratory depression—a known side effect of opioids—and, in rare cases, can raise the risk of overdose.”
In the retrospective cohort study, the investigators used Medicare claims linked to medication dispensing records from a large commercial SNF pharmacy. The study population included older Medicare fee-for-service beneficiaries hospitalized for a hip fracture between 2012 and 2018 who were discharged to an SNF.
“Our first finding, which may sound simple but is actually quite important, is that about 84% of people with a hip fracture received some form of pain medication,” Hayes said. “The medications ranged from over-the-counter drugs like acetaminophen to opioids such as hydrocodone and oxycodone. Within three months after a hip fracture, most patients had at least one pain medication prescribed.”
The investigators followed study participants from their first day in an SNF for up to 100 days and described opioid, nonopioid analgesic, and gabapentin medication regimens dispensed overall.
The study included 88,433 eligible and matched individuals with an average age at SNF entry of 84.8 years. Of this group, 83.7% were treated with pain medication in the first 100 days following SNF admission, with the most prevalent pain medication being hydrocodone plus acetaminophen (16.7% prevalence overall), followed by oxycodone plus acetaminophen (11.2%).
Dispensing of most medication regimens declined by more than 50% after 30 days, with oxycodone-based regimens declining more than hydrocodone-based ones.
However, there was an increase in several opioid-based regimens observed between days 60 and 100.
For patients prescribed gabapentin in the first 15 days following hospitalization, 91% were co-prescribed an opioid regardless of prior gabapentin use before the hip fracture.
“But the main takeaway I’d want clinicians and medical directors of SNFs to remember is to be alert to potential drug-drug interactions, especially between gabapentin and opioids,” Hayes said. “Gabapentin can cause side effects and when combined with other commonly used pain medications after a hip fracture, those risks can increase. Promoting awareness of that interaction, and encouraging more careful prescribing and medication review, could go a long way toward improving safety for these patients.”
—Kenny Walter
