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Opioids and risk of falls in the elderly

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Opioids increase risk of falls and the risk is most prominent in older adults (1,2)

Opioid use increases fall risk through (1):

  • drowsiness
  • dizziness
  • cognitive impairment
  • (orthostatic) hypotension
    • buprenorphine, fentanyl, hydromorphone, morphine and oxycodone use has been associated with orthostatic hypotension (1)
      • risk of hypotension increased with concomitant use of other drugs such as benzodiazepines
  • and hyponatremia (caused by weak opioids) (1)

In a population-based cohort study of 3.2 million people who initiated prescription opioid treatment, opioid exposure was associated with increased risk of serious fall events among adults of all ages (2)

  • risk significantly increased with age and within the first 28 days of commencing opioid use
  • results of this study suggest that fall risk should be considered when prescribing opioids in adults, particularly in the first 4 weeks of treatment, and among individuals with preexisting risk factors for falls, including older age
  • risk of falls was highest among those 85 years or older (adjusted incident rate ratio, 6.35; 95% CI, 6.20-6.51)


  1. Virnes RE, Tiihonen M, Karttunen N, van Poelgeest EP, van der Velde N, Hartikainen S. Opioids and Falls Risk in Older Adults: A Narrative Review. Drugs Aging. 2022 Mar;39(3):199-207.
  2. Hopkins RE, Bharat C, Buizen L, et al. Age-Related Risk of Serious Fall Events and Opioid Analgesic Use. JAMA Intern Med. Published online February 19, 2024. doi:10.1001/jamainternmed.2023.8154

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