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Policies and regulations on opioid use have evolved from being primarily state-to federally based. We examined the trends and variation in chronic opioid use among states and nursing homes. Retrospective cohort study. We used the nursing home Minimum Data Set and Medicare claims from 2014 to 2018 and included long-term care nursing home residents from each year who had at least 120days of consecutive stay. Chronic opioid use was defined as use for ≥90days. Three-level hierarchical logistic regression models (resident, nursing home, stat
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