- Design
- Population-based retrospective cohort using linked administrative data
- Population
- 114,055 adults aged ≥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 Ontario population cohort used linked administrative data on 114,055 adults aged 66 and over admitted with hip fracture between 2008 and 2024 who survived at least nine months, and tracked dispensing of opioids and benzodiazepines in the year after discharge.
Benzodiazepine dispensing fell from 33.7% in 2008 to 13.3% in 2024. Opioid dispensing peaked at 55.8% in 2015 and was still 44.6% in 2024. Concurrent prescribing of both fell from 3.7% to 1%. Most patients on 90 days or more of continuous opioids were below 50 mg daily morphine equivalent.
The benzodiazepine trend shows that deprescribing campaigns can change practice. The opioid figure is harder to interpret: some pain after hip fracture needs opioids, and the study cannot say how much of the 45% was appropriate. What it does show is that nearly half of older people leave a hip fracture admission with an opioid supply, which needs a plan for stopping.
- Write an opioid stop or review date on the discharge summary after hip fracture.
- Use regular paracetamol as the analgesic foundation, and the lowest effective opioid dose.
- Avoid starting benzodiazepines for sleep or anxiety after a fracture.
- Review any opioid still being taken at the 6-week follow-up.
- Never co-prescribe opioids and benzodiazepines without a clear indication.
Why it matters
Benzodiazepine deprescribing worked; opioid prescribing after fracture has not had the same attention.
Don't overread it
Dispensing data cannot say whether opioids were appropriate or how long they were actually taken.
The statistics, in plain English
These are percentages of patients with at least one prescription dispensed in the year after discharge. A single short course counts the same as months of use, so 44.6% overstates long-term opioid use. The study describes trends; it does not judge whether prescriptions were appropriate.
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