Risk of Injury Associated with Opioid Use in Older Adults

Authors

  • David Buckeridge MD, PhD,

    1. From the Departments of *Epidemiology and Biostatistics, Medicine, and Mathematics and Statistics, McGill University, Montreal Quebec, Canada.
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  • Allen Huang MD, CM,

    1. From the Departments of *Epidemiology and Biostatistics, Medicine, and Mathematics and Statistics, McGill University, Montreal Quebec, Canada.
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  • James Hanley PhD,

    1. From the Departments of *Epidemiology and Biostatistics, Medicine, and Mathematics and Statistics, McGill University, Montreal Quebec, Canada.
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  • Armel Kelome PhD,

    1. From the Departments of *Epidemiology and Biostatistics, Medicine, and Mathematics and Statistics, McGill University, Montreal Quebec, Canada.
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  • Kristen Reidel BSc,

    1. From the Departments of *Epidemiology and Biostatistics, Medicine, and Mathematics and Statistics, McGill University, Montreal Quebec, Canada.
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  • Aman Verma MSc,

    1. From the Departments of *Epidemiology and Biostatistics, Medicine, and Mathematics and Statistics, McGill University, Montreal Quebec, Canada.
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  • Nancy Winslade PharmD, MSc,

    1. From the Departments of *Epidemiology and Biostatistics, Medicine, and Mathematics and Statistics, McGill University, Montreal Quebec, Canada.
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  • Robyn Tamblyn PhD

    1. From the Departments of *Epidemiology and Biostatistics, Medicine, and Mathematics and Statistics, McGill University, Montreal Quebec, Canada.
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Address correspondence to Robyn Tamblyn, McGill University, Morrice House, 1140 Pine Ave W., Montreal Quebec, Canada H3A 1A3. E-mail: robyn.tamblyn@mcgill.ca

Abstract

OBJECTIVES: To estimate the dose-related risk of injuries in older adults associated with the use of low-, medium-, and high-potency opioids.

DESIGN: Historical population-based cohort study: 2001 to 2003.

SETTING: Quebec, Canada's, universal healthcare system.

PARTICIPANTS: Four hundred three thousand three hundred thirty-nine adults aged 65 and older.

MEASUREMENTS: Population-based health databases were used to measure preexisting risk factors for injuries in 2001/02 and drug use and injuries during follow-up (2003). Type and dose of opioids were measured as time-dependent variables, as were other drugs that may increase the risk of injury from sedating side-effects or hypotension. The risk of injury per one adult dose increase in opioid dose was estimated using multivariate Cox proportional hazards models.

RESULTS: During the follow-up year, 50.7% of the study population were prescribed drugs with sedating side effects, 15.3% were prescribed an opioid, 20.7% were concurrently using more than one sedating medication, and 3.7% were treated for an injury, fractures (55.1%) being the most common. After adjusting for concurrent drug use and baseline risk factors, low- (hazard ratio (HR)=1.36, 95% confidence interval (CI)=1.33–1.39) and intermediate-potency (HR=1.05, 95% CI=1.02–1.07) opioids were associated with the risk of injury. Use of codeine combinations was associated with the highest risk of injury, a 127% greater risk (HR=2.27, 95% CI=2.21–2.34) per one adult dose increase. (The mean World Health Organization standardized dose in the study population was 1.71 ± 0.85 adult doses.)

CONCLUSION: Opioids increase the risk of injury in older adults, particularly codeine combinations.

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