by: Eric Widera ( @ewidera ) If you had to guess what long acting opioid is most commonly started on in nursing home patients, which one would you guess? A new study released last week in JAGS shocked me. The answer to this question was a fentanyl patch. Even more shocking, many of those started on this medication were never prescribed any opioids prior to being started on a patch. Ok, before I get ahead of myself, let me describe the study. The authors used nursing home data from 22,253 Medicare-enrolled long-stay residents (meaning that they had to have a stay of greater than 90 days). They combined the Minimum Data Set (MDS) with Medicare enrollment, hospital claims, and prescription drug transaction data from January to December of 2011 to determine the prevalence of new initiation of a long-acting opioid prescriptions. They excluded residents who were comatose, who did not initiate a long-acting opioid after nursing home admission, or who had less than 3