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Risk of Injury Associated with Opioid Use in Older Adults
Author(s) -
Buckeridge David,
Huang Allen,
Hanley James,
Kelome Armel,
Reidel Kristen,
Verma Aman,
Winslade Nancy,
Tamblyn Robyn
Publication year - 2010
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2010.03015.x
Subject(s) - medicine , hazard ratio , confidence interval , opioid , population , cohort study , proportional hazards model , poison control , cohort , injury prevention , emergency medicine , anesthesia , environmental health , receptor
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.