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Comparing Fall Risk in Older Adults on Chronic Opioids versus Buprenorphine Therapy
Thursday April 24, 2025 10:10am - 10:25am EDT
Athena C
Title: Comparing Fall Risk in Older Adults on Chronic Opioids versus Buprenorphine Therapy


Authors: A. Garrett Allegra, Olivia Caron, Tasha Woodall


Objective: To analyze potential differences in fall risk in older adults on chronic full-agonist opioid therapy versus chronic buprenorphine therapy


Self Assessment Question: What correlation, if any, was seen in this study between buprenorphine use and fall risk reduction when compared to full-agonist opioids?


Background: Minimizing fall risk in older adults is a pillar of geriatric medicine, and pharmacists play an important role in decreasing the use of fall-risk-increasing drugs (FRIDs) in this population1. One such class of medications is opioids, which have been shown to significantly increase fall risk, injury from falls, and fractures in older adults2. Some data suggest that buprenorphine, a partial opioid agonist, increases fall risk as well; however, buprenorphine and full-agonist opioids have not been directly compared3. The objective of this study was to examine the rate of positive fall screenings among older adults prescribed opioids versus those prescribed buprenorphine.


Methods: Eligible patients met the following inclusion criteria: family medicine patient at Mountain Area Health Education Center (MAHEC) in Asheville, NC; age > 65 years at time of fall screen; and active buprenorphine, full-agonist opioid, or partial-agonist opioid on medication list at time of fall screen. Patients taking both buprenorphine and a full-agonist opioid and patients whose opioid was prescribed for an acute injury related to a fall were excluded. A retrospective chart review of eligible patients was conducted to compare the rate of positive fall screenings among patients who take chronic opioids versus patients who take chronic buprenorphine. Data collected during these chart reviewed included opioid product on medication list, duration of therapy, milligram morphine equivalents (MMEs), fall risk screening score, renal function, and concomitant FRIDs for comparison.


Results: A pre-existing registry of 733 patients who take chronic opioids was analyzed to identify 211 older adults who were taking chronic opioid therapy at the time of their most recent fall screening. An additional registry was compiled listing 80 patients taking chronic buprenorphine. This list was analyzed via chart review to identify 29 older adults who were taking buprenorphine at the time of their most recent fall screening. Data analysis was performed and yielded no significant difference in positive fall risk screening rates between individuals taking buprenorphine and those taking full agonist opioids (69% vs 58%, p-value not reported). There was also no difference seen in rates of injuries from fall between groups (24% for buprenorphine, 25% for opioids). There was a statistically significant difference in fall rate between all female patients enrolled in the trial (65%) compared to male patients (48%, p=0.037) and between all patients under 75 years old (52%) and those 75 years or older (69%, p=0.026). 


Conclusion: This trial showed no statistical difference in fall risk between buprenorphine and full agonist opioids in adults aged 65 years or older. There was, however, a significant increase in fall risk among women and patients 75 years or older who take an opioid product of any kind. The association between various opioid products and fall risk among subpopulations warrants further investigation with larger sample sizes.
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Presenters
avatar for Garrett Allegra

Garrett Allegra

PGY1 Pharmacy Resident, Mountain Area Health Education Center
Garrett is from Winchester, Virginia and completed undergraduate education at Virginia Tech before going to pharmacy school at Virginia Commonwealth University. At VCU, he developed a strong interest in ambulatory care, particularly in the areas of cardiology, diabetes, and substance... Read More →
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Thursday April 24, 2025 10:10am - 10:25am EDT
Athena C
  Ambulatory Care (AMB), Mountain Area Health Education Center /UNC Eshelman School of Pharmacy
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