Design: Population-based retrospective cohort, linked administrative data
Population: 114,055 adults ≥66 admitted with hip fracture, Ontario, 2008–2024
Primary outcome: Opioid and benzodiazepine dispensing within 1 year of discharge
Effect: Benzodiazepines 33.7% → 13.3%; opioids peaked 55.8% (2015), 44.6% in 2024

This retrospective cohort used linked Ontario administrative data on 114,055 adults aged 66 or over admitted with hip fracture between 2008 and 2024 who survived most of the following year, recording opioid and benzodiazepine dispensing before admission and for a year after discharge.

Benzodiazepine dispensing after discharge fell from 33.7% to 13.3% over the period. Opioid dispensing peaked at 55.8% in 2015 and was still 44.6% in 2024. Concurrent opioid and benzodiazepine dispensing fell from 3.7% to 1%. Most of those with 90 days of continuous opioid use were on under 50 mg morphine equivalents a day.

The benzodiazepine decline shows that deprescribing campaigns can shift practice. Opioids are often needed after hip fracture, but nearly half of patients still receiving them over the following year suggests the step-down plan is often missing. Indian prescribing patterns may differ, and tramadol is more widely used here.

Write an opioid step-down plan in the discharge letter after hip fracture surgery.
Review opioid need at each follow-up in the first three months after fracture.
Avoid starting benzodiazepines for sleep or anxiety after hip fracture.
Avoid co-prescribing opioids and benzodiazepines in older adults.
Use regular paracetamol and non-drug measures as the base of post-fracture analgesia.

Why it matters

It shows benzodiazepine deprescribing worked at population scale, and opioids have not followed.

The statistics, in plain English

Dispensing percentages show how many patients received at least one prescription in the year after discharge; they do not show dose, duration or whether the drug was needed. These are trends in one Canadian province.