Trends in Dispensing of Opioids and Benzodiazepines Among Older Adults Admitted for an Acute Hip Fracture Between 2008 and 2024 in Ontario, Canada

Abstract

INTRODUCTION: Opioids and benzodiazepines (BZDs) are commonly prescribed for managing pain, anxiety, and sleep-related problems following a hip fracture. Both opioids and BZDs carry risks of persistent dependence, falls, and mortality with long-term use. Despite these risks, Canada lacks standardized prescribing guidelines for older adults with hip fracture. We examined population-level trends in opioids and BZDs dispensing before hospitalization and up to 1-year post-discharge among older adults admitted for hip fractures in Ontario, Canada. METHODS: We conducted a retrospective cohort study using linked health administrative data from ICES, Ontario, Canada. The cohort included individuals aged 66 years and older, residing in Ontario, admitted for an acute hip fracture between April 1, 2008, and March 31, 2024, and who survived for at least 275 days in the following year. Our primary outcome was post-discharge opioids and BZDs dispensed, defined as ≥ 1 prescription dispensed within 1-365 days following discharge. Secondary outcomes included pre-hospitalization dispensing, concurrent dispensing, and morphine equivalent dose. RESULTS: A total of 114,055 eligible older adults were admitted with hip fractures between 2008 and 2024. Overall, BZDs dispensing declined from 33.7% in 2008 to 13.3% in 2024, while opioids dispensing peaked in 2015 at 55.8% and decreased to 44.6% in 2024. Hydromorphone and combination drug therapy were the most frequently dispensed opioid drug classes during pre-hospitalization and post-discharge periods following a hip fracture. Concurrent opioids and BZDs dispensed following a hip fracture decreased from 3.7% in 2008 to 1% in 2024. Among individuals with 90 days of continuous opioid dispensed, most received < 50 mg average daily morphine equivalents. CONCLUSION: We observed a substantial reduction in BZDs dispensing. However, opioids dispensing remained consistently high. These findings underscore the need for future research on initiatives to reduce opioids use in post-fracture care, while recognizing that opioids remain an effective pain control drug.