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- Page navigation anchor for RE: Association between falls and opiate prescriptionsRE: Association between falls and opiate prescriptions
We agree that our study can only demonstrate an association, not cause and effect. In our limitations section we clearly specified: “The retrospective design of the study can demonstrate only an association between opioid use and falls; no causal relationship between the two phenomena can be inferred. We can hypothesize that because patients generally use opioids to treat pain, it may be the pain itself (and not the opioid) that causes the fall. Furthermore, our definition of opioid use is filling an opioid prescription in the previous 2 weeks, and it is possible that the drug was not consumed by the patient.”
However we controlled for pre-existing confounding variables “depression, anxiety, alcoholism, falls leading to hospital admission, diagnosis of malignant tumour or other comorbidities (asthma, diabetes, high blood pressure, Parkinson disease, chronic airway obstruction, renal failure, heart failure, coronary artery atherosclerosis and dementia) during the year preceding the injury. Finally, we searched in the RAMQ medication database for at least 1 filled prescription of medication known to affect balance according to the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (antidepressant, antipsychotic, benzodiazepine, anticholinergic, antithrombotic and cardiovascular drugs) during the 14 days preceding the target trauma.”We also agree that not treating older patients' pain is associated with a diminish quality of life,...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Association between falls and opiate prescriptionsRE: Association between falls and opiate prescriptions
I find this kind of study disquieting. Although you note there is an association and not cause and effect, many will view it as cause and effect. The premise is flawed from the beginning. There is no evidence that these patients consumed the opiates, no blood levels to state they were under the influence. Clearly their physicians felt that what their underlying infirmity was was significant enough and painful enough to warrant opiod prescription. They had underlying infirmities significant enough to cause falls with or without opiates. While I do think in some instances opiates are over-prescribed to elderly patients, prescribed at too high doses, and they certainly carry significant side effects such as constipation in this population, I do not believe that your study is helpful. It may cause more disability for patients with chronic pain who are functional on opiates. Without them they will not be functional and will be in pain. Your failure to state what the underlying disease processes that caused pain and then opiate prescription makes your study flawed.There is no way to know whether your control group is relevant or adequate.
Competing Interests: None declared.