Older adults who take opioids after being diagnosed with dementia have a higher risk for dying — and that risk is 11 times higher during the first two weeks after starting the drugs. This is according to a new study presented at the Alzheimer’s Association International Conference in Amsterdam. 

Researchers looked at data from 75,471 people over the age of 65 in Denmark who were diagnosed with dementia from 2008 and 2018. The subjects included those living at home and in nursing care facilities. A total of 42% had a prescription for an opioid.

After following those on opioids for 180 days and comparing the data to people with dementia who didn’t take opioids, researchers found that 33.1% of people died within 180 days after starting their first opioid while only 6.4% died who didn’t have a prescription. Data showed a fourfold higher risk for excess death in those taking opioids. The risk increased in the first 14 days after starting the medications; that’s when mortality for all opioids was 11 times over the norm.

“In our study, starting on an opioid after getting a dementia diagnosis was frequent and associated with a markedly increased risk of death, which is worrisome,” Christina Jensen-Dahm, MD, PhD, a researcher in the neurology department at the Danish Dementia Research Center in Copenhagen University Hospital, said in a statement. “Our study shows the importance of careful evaluation of risk and benefits to the patient when considering initiating opioid therapy among elderly individuals with dementia.”

Strong opioids were linked to a sixfold increased mortality risk among those diagnosed with dementia, the study found. Fentanyl patches were especially risky. Of people who used fentanyl patches, 64.4% died in the first 180 days after taking them compared to 6.4% of people who didn’t take fentanyl. That means they were eight times more likely to die if they had dementia and took fentanyl within 180 days after starting the prescription.

Strong opioids included morphine, oxycodone, ketobemidone, hydromorphone, pethidine, buprenorphine and fentanyl, according to the team. These are often the go-to when non-opioid pain relievers and mild opioid medicines don’t work. 

The Alzheimer’s Association weighed in on the findings.

“Opioids are very powerful drugs, and while we need to see additional research in more diverse populations, these initial findings indicate they may put older adults with dementia at much higher risk of death,” Nicole Purcell, DO, MS, a neurologist and Alzheimer’s Association senior director of clinical practice, said in a statement.

“These new findings further emphasize the need for discussion between the patient, family and physician,” Purcell said. “Decisions about prescribing pain medication should be thought through carefully, and, if used, there needs to be careful monitoring of the patient.”