Opioid use increases risk for serious falls among all ages, researchers find

Key takeaways:

• Among adults aged 18 to 44 years, the rate of serious falls was 5.5 times higher in the first 28 days after opioid initiation.
• Researchers said fall risks should be considered when prescribing opioids.

Opioid use was associated with an increased risk for serious falls among all age groups, especially during the first 28 days after initiation, according to a study published in JAMA Internal Medicine.

Previous research has reported that unintentional falls are currently the leading cause of injury and injury-related deaths among older adults in the United States, while falls are also a leading cause of hospitalization among younger and middle-aged adults, Ria E. Hopkins, PhD, a postdoctoral fellow from the National Drug and Alcohol Research Center, in Australia, and colleagues explained.

However, “to our knowledge, there is limited research specifically examining the age-related risk of falls associated with opioid use, with few population-based studies including adults of all ages,” they wrote. “There is also limited evidence about the effects of opioid doses, and there is a need for research using robust measures of opioid exposure that account for the dynamic nature of clinical opioid use.”

In a retrospective cohort study, the researchers examined data — taken from the POPPY II population-based study — on Australian adults (n = 3,212,369) aged 18 years or older who had initiated opioids between 2005 and 2018.

Overall, 9.3% of the cohort experienced a serious fall event, and there were 5,210 fatal events.

Hopkins and colleagues found that during exposure to opioids, the risk for serious falls increased among all age groups, but the risk was highest among those aged 85 years and older (adjusted incidence rate ratio = 6.35; 95% CI, 6.2-6.51) compared with those aged 18 to 44 years.

For all age groups, the risk for serious falls was highest during the first 28 days after opioid initiation. For example, among individuals aged 18 to 44 years, the rate of serious falls was 5.5 (95% CI, 5.31-5.7) times higher in the first 28 days of initiating opioids and 1.9 (95% CI, 1.85-1.96) times beyond 28 days vs. at baseline.

The researchers added that risks for serious falls were also associated with increasing opioid doses among individuals aged 18 to 84 years.

There were some limitations to the study, like a possible underestimation of the true incidence of falls, “particularly among younger people who may be less likely to experience injury or seek medical attention,” Hopkins and colleagues wrote.

They concluded that risks should be considered when prescribing opioids, “particularly for individuals with preexisting risk factors for falls, including frailty and older age, or when opioids are prescribed at higher doses.”

“The first month following opioid initiation represents a period during which targeted prevention efforts may be most effective,” they wrote.