RT Journal
A1 Rastegar DA
T1 SAfety of opioids in older adults
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2011
FD June 27
VO 171
IS 12
SP 1126a
OP 1126
DO 10.1001/archinternmed.2011.264
UL http://dx.doi.org/10.1001/archinternmed.2011.264
AB 
Solomon and colleagues1 provide observational evidence that the use of opioids in older adults is associated with a number of adverse outcomes, including fracture, cardiovascular events, and all-cause mortality. While the increase in fracture and all-cause mortality seems plausible, the association with cardiovascular events is surprising. The authors acknowledge that this finding was unexpected and could be due to residual confounding. One unmeasured factor that could explain this observation is smoking. A number of studies have shown that smokers are more likely to be prescribed opioids for chronic pain.2- 3 Moreover, the association with smoking may be contributing to the observed increase in all-cause mortality and risk of fracture.4 Smoking is an important factor that needs to be taken into account when investigating these associations.