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 Researchers studied more than 67,000 injured patients over age 65
who were admitted to trauma centers in Quebec between 2004 and 2014.
The average age was 81.
Overall, people with a recent opioid prescription were 2.4 times
more likely to have been injured in a fall than other trauma
patients, the study found.
And among all patients with fall-related injuries, those with recent
opioid prescriptions were 58 percent more likely to die in the
hospital than patients who were not using these painkillers.
"The effect of opioids is similar to alcohol - your reflexes are
slower and your balance is affected, which makes you more likely to
fall," said lead study author Dr. Raoul Daoust of the University of
Montreal in Quebec.
It's possible that the chronic pain or health problems that led to
the opioid prescriptions - and not the painkillers themselves -
might actually cause falls, Daoust said by email. But the results
still suggest patients should consider using other pain relievers
like acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs
(NSAIDs) such as ibuprofen (Motrin) or naproxen (Aleve).
"Only take opioids if other painkillers do not work," Daoust
advised.
Falls are a leading cause of disability and death among people 65
and older, researchers note in CMAJ.
While some previous research has linked opioid use to an increased
risk of falls, results have been mixed and studies to date haven’t
provided a clear picture of the severity of injuries or the risk of
death for elderly patients.
In the current study, 92 percent of the patients were injured in
falls and 59 percent of the patients required surgery. Half of them
were hospitalized for at least 12 days.
The vast majority of these trauma patients had not been prescribed
opioids within the two weeks prior to their injury.
Almost 5 percent of the patients who had recently filled an opioid
prescription had been injured in a fall, compared to 1.5 percent of
people with other types of injuries.
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The study wasn’t a controlled experiment designed to prove whether
or how opioids might directly cause falls or fatalities, the authors
note. Another limitation is that they examined prescription data,
and it's possible some patients might not have taken opioids that
doctors prescribed.
Still, the results suggest that patients should consider alternative
painkillers when possible, and be aware of the potential risk of
falls with opioids, said Brendan Saloner, a researcher at Johns
Hopkins Bloomberg School of Public Health in Baltimore who wasn't
involved in the study.
"Opioids act on the central nervous system and often have a sedating
effect, so people may feel drowsier after taking opioids or may
experience reduced motor functioning, which may cause them to lose
their balance and become more at risk of falls," Saloner said by
email.
"However, people who take opioids are often more frail because of
their medical histories, and their underlying disability may also
increase their risk of falls - for example, they may be people who
use walkers or who have vision problems," Saloner added.
One way to avoid the risk may be to try not to start opioids in the
first place, said Dr. Jennifer Stevens, a researcher at Beth Israel
Deaconess Medical Center and Harvard Medical School in Boston who
wasn’t involved in the study.
Many patients get started on opioids after a hospital stay, and once
they start they run the risk of staying on the drugs for a long
period of time, Stevens said by email. Patients should ask their
doctors about alternatives, Stevens advised.
"There are a range of other medications that . . . may even be more
helpful to acute pain, post surgical pain, and even chronic pain,"
Stevens said.
SOURCE: http://bit.ly/2Hpwcaz CMAJ, online April 23, 2018.
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