Prescription opioids found to increase the risk of falls, especially in those over 85

A new study led by researchers at the National Drug and Alcohol Research Center (NDARC), UNSW Sydney, has explored the association between prescription opioid use and falls.

The study, published in JAMA Internal Medicine, examined falls that led to emergency department visits, hospital admissions, and death following a new opioid dispensing among 3.2 million people in the POPPY II study cohort. The POPPY II study is a retrospective cohort of NSW residents who initiated a prescription opioid through the Pharmaceutical Benefits Scheme between 2003 and 2018.

Lead author and Postdoctoral Research Fellow Dr. Ria Hopkins said the study found that current opioid use was associated with a substantial risk of a serious fall among all age groups. Overall, 1 in 10 people in the cohort experienced a serious fall during the study period, with higher rates among periods of opioid use compared to periods of no opioid use.

Compared to younger adults (18–44 years), the risk of a serious fall was six times higher for people aged 85 years and over during periods of opioid use, after accounting for other medicines and factors which may increase the risk of falls. Falls are a major cause of injury in Australia, and older people are at particular risk of serious negative consequences, including major injury and death.

"Although we expected to see increased fall risk among older individuals, we were surprised by how many falls there were among younger adults which resulted in emergency department visits and hospitalizations," said Dr. Ria Hopkins. "These findings demonstrate the need for doctors to be aware of and inform people of all ages about the risks of these types of injuries when starting or continuing opioid medicines."

The month immediately following opioid initiation was also identified as a time of particularly high risk for serious falls among adults of all ages, and risk increased as daily doses of opioids increased.

Over the last thirty years, there have been concerns about the safety and appropriateness of opioid prescribing. One key concern is the potential for opioid use to increase the risk of falling among older adults due to the sedating effects of these medicines.

This study provides new data demonstrating that this risk is not exclusive to older adults and that fall prevention and education should be considered for all adults prescribed opioids, particularly when beginning treatment.

Senior author Scientia Associate Professor Natasa Gisev said, "Our findings showed that falls are a relatively common adverse event among people using prescription opioids. Many falls are preventable, and while there is a large focus on interventions aimed at preventing falls among older adults, more work is needed to reduce the risk among younger adult populations."