Does opioid use for people living with dementia meet best practice?

University of Auckland doctoral student Hoda Fahmy is launching the first ever study on opioid use among people with dementia in aged residential care in Aotearoa.

The research has been made possible thanks to a $260,000 Health Research Council Early Career Development Award. She plans to use health databases to examine opioid use of patients diagnosed with dementia who live in residential aged care, between 2017 and 2022. This group comprises about 40 percent of all those diagnosed with dementia in New Zealand.

Fahmy aims to uncover patterns of opioid use in people living with dementia, and risk factors that predict persistent use over more than three months. Research shows opioid medicines are increasingly prescribed for people living with dementia to manage pain, behavioural and neuropsychiatric symptoms, she says.

“The efficacy and safety of opioids in this population is underexplored – and that’s a concern. Another concern is that people living with dementia are particularly susceptible to opioid-induced side effects.” Side effects from opioids include drowsiness, cognitive dysfunction and constipation.

Existing policies for prescribing and monitoring opioids in aged residential care facilities will be reviewed against local and international guidelines. She wants the research to contribute to safer prescribing and ways to reduce the risks for older New Zealanders. A common issue is the difficulty people with dementia have communicating pain, potentially increasing the use of opioids.

“Although opioids often come with a lot of stigma and negative perceptions, the key lies in their appropriate use and vigilant monitoring. Some people do need opioids, but there are concerns generally about persistent use if they’re not needed,” she says.

The research will include people aged under 65, who have young-onset dementia, as well as older people with the condition. Māori are more likely to live with dementia and are on average 8.5 years younger than Pākehā when diagnosed. A recent Health Quality and Safety Commission report stated Māori aged 25 to 79 were more likely to be prescribed strong opioids than non-Māori.