WASHINGTON, D.C. — The Department of Health and Human Services Office of the Inspector General has launched a comprehensive audit examining how state agencies oversee nursing home pharmacy operations to prevent opioid-related harm among more than 150,000 residents currently receiving these medications.
The federal watchdog agency announced the investigation on Tuesday, noting that state survey agencies recently cited approximately half of the nation's 15,000 certified nursing homes for deficiencies in pharmaceutical services during routine health inspections and complaint investigations, according to the announcement.
The audit, designated as Project OAS-26-01-027, will specifically examine whether selected state agencies have ensured nursing facilities comply with federal and state pharmacy service requirements designed to prevent opioid overuse, misuse and diversion among Medicare and Medicaid residents. Officials project the study will be completed in fiscal year 2028, as reported by the Office of Inspector General.
"If effective systems and procedures to ensure the safe and effective use of medications are not implemented, over 157,000 nursing home residents who receive opioids could be at risk for overuse, misuse or diversion," the agency stated in its public notice.
The investigation comes as the opioid crisis continues to impact vulnerable populations nationwide. Federal officials first declared the opioid epidemic a public health emergency in 2017 and have renewed that designation annually. Since that declaration, opioid overdoses have claimed more than 700,000 lives across the United States, with nearly 6 million individuals experiencing addiction or disability from these drugs, including many elderly nursing home residents, according to federal health data.
Federal regulations require nursing homes to maintain pharmaceutical services that include procedures ensuring accurate acquisition, receipt, dispensing and administration of all medications. Facilities must also store controlled substances securely, limit access to authorized personnel only, and provide locked, secure compartments specifically for Schedule II drugs.
Lisa Morris, a pharmacist and executive director of clinical services at medication management company Consana Health Services, told McKnight's Long-Term Care News that the investigation represents a "timely and important topic."
"I think the OIG's decision to do this study could be a positive as long as the goal is to elevate best practices and foster interdisciplinary collaboration for the benefit of the patient, rather than being punitive," Morris stated. "Consultant pharmacists are already deeply engaged in these efforts, so in many ways, the study validates the importance of what they've been doing all along."
Morris explained that consultant pharmacists play a critical role in overseeing the complete medication-use process, ensuring proper chain of custody for controlled substances from procurement through administration and disposal. These professionals also identify potential risk points in pharmacy operations and help implement strategies to reduce the likelihood of medication overuse, misuse or diversion, according to her statement.
National Context on Opioid Safety
While opioid overdose deaths among the general population declined last year for the first time in two decades, experts emphasize that nursing homes must continue reducing their reliance on these medications. Under pressure from federal healthcare officials in recent years, long-term care facilities have decreased opioid use, but significant improvements remain necessary, as reported by industry experts.
Research completed last fall identified major gaps in tracking opioid use among nursing home patients covered by Medicare, highlighting ongoing challenges in medication monitoring systems.
The widespread failure of nursing homes to meet pharmaceutical service standards raises concerns about medication safety protocols across the long-term care industry. The high rate of deficiencies suggests systemic issues in how facilities manage controlled substances and implement safeguards against improper medication use.
Implications for Residents and Families
The investigation will examine state-level oversight mechanisms that are designed to protect nursing home residents from medication-related harm. Family members of residents receiving pain management should be aware of federal requirements for secure medication storage and proper administration protocols.
Nursing homes are required to have systems in place that prevent unauthorized access to controlled substances and ensure medications are distributed only to appropriate residents by authorized personnel. Facilities must also maintain accurate records of medication procurement, distribution and disposal.
Resources for Families
Families with concerns about medication management or pharmacy practices at nursing facilities can contact the National Long-Term Care Ombudsman Resource Center at 1-800-677-1116. The ombudsman program provides free, confidential assistance to nursing home residents and their families.
Additional concerns about pharmacy services or medication safety can be reported to state survey agencies responsible for nursing home inspections. Family members should document any observations of improper medication storage, unauthorized personnel handling controlled substances, or residents experiencing unexpected side effects from pain medications.
The federal investigation is expected to provide insights into how effectively states monitor nursing home compliance with pharmacy safety standards and may lead to enhanced oversight measures to protect vulnerable residents receiving opioid medications.
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