A study released during the July 2023 meeting of the Alzheimer’s Association International Conference in Amsterdam, Netherlands that followed participants for 180 days after their first opioid prescription and also followed a group of adults 65 and older who had dementia who did not receive an opioid prescription, compared the risk of death between the two groups and reported:

  • 10,474 (33.1%) study participants died within 180 days after initiating their first opioid prescription, compared with 3,980 (6.4%) of the unexposed. After adjusting for potential differences between groups, researchers found a fourfold increased excess mortality risk.
  • The risk was greatest in the first 14 days, where mortality for all opioids was increased elevenfold.
  • Strong opioids were associated with a sixfold increased mortality risk.
  • Among those who used fentanyl patches as their first prescription, 64.4% died within the first 180 days compared with 6.4% in the unexposed (an eightfold increased risk of dying).

The researchers defined strong opioids as morphine, oxycodone, ketobemidone, hydromorphone, pethidine, buprenorphine and fentanyl. Strong opioids are used to relieve pain when non-opioid and mild opioid medicines are not effective.

The study population included everyone in Denmark aged 65 and older diagnosed with dementia between January 1, 2008 and December 31, 2018 (75,471 people), including both those living at home and those living in nursing homes. Of that group, 42% (31,619) of those diagnosed with dementia filled a prescription for an opioid at a pharmacy.

One of the researchers stated with regard to their study, “In our study, starting on an opioid after getting a dementia diagnosis was frequent and associated with a markedly increased risk of death, which is worrisome. The use of strong opioids has increased considerably over the past decade among older people with dementia. Our study shows the importance of careful evaluation of risk and benefits to the patient when considering initiating opioid therapy among elderly individuals with dementia. Opioids are known to have significant side-effects including sedation, confusion, respiratory depression and falls. Older adults with dementia have a severe brain disorder and are often frail. We suspect this is why they can not tolerate opioids, but we do not know for certain and need to do more research to answer these questions.”

A group of drugs used to treat psychiatric conditions, known as atypical antipsychotics, have consistently been found to nearly double the risk of death in the elderly population.

Source

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