# Drug interactions and opioid-related emergency room visits and hospitalizations among older adults

> **NIH AHRQ R01** · BRIGHAM AND WOMEN'S HOSPITAL · 2020 · $399,999

## Abstract

Older adults are at high risk of opioid-related adverse effects even when they use these medications as
prescribed. Approximately one in three older adults receives at least one opioid prescription each year and many
receive high amounts, with average doses that exceed recommendations on the drug labels. Opioids are
responsible for more than 35,000 emergency room visits, nearly 125,000 hospitalizations, and nearly 9,000
deaths among older adults each year. Polypharmacy among older adults who use opioids is especially high. As
compared to patients who do not use opioids, those that use opioids are more likely to have many other
comorbidities, including depression and cardiovascular disease. On average, patients who use opioids fill 52
prescriptions per year from about 10 drug classes. A number of medications that are commonly used by older
adults may interact with opioids to increase risk of opioid-related adverse events. For example, oxycodone, one
of the most commonly used medications for chronic pain and the drug most frequently involved in opioid
overdoses, is metabolized by the liver enzymes cytochrome P450 3A4 (CYP3A4) and CYP2D6. The selective-
serotonin reuptake inhibitors (SSRIs) fluoxetine and paroxetine, which are among the most widely used
antidepressant medications, inhibit CYP3A4. Interactions between these drugs could increase oxycodone
concentrations in the body and potentially increase risk of adverse events leading to opioid-related emergency
room visits and hospitalizations. Fentanyl is also metabolized by 3A4, hydrocodone is metabolized by 2D6, and
tramadol is metabolized by 3A4, 2D6, and 2B6. Despite the potentially important role that drug interactions may
play in older adults, little is known about whether these putative interactions are likely increase opioid-related
emergency room visits and hospitalizations and whether there may be safer treatment alternatives for patients
requiring opioid treatment. The overarching goal of this project is to generate novel evidence that will help
patients and healthcare providers identify and avoid important drug interactions with opioids that have the
potential to increase risk of opioid-related emergency room visits and hospitalizations. This project will focus on
three comorbid conditions (depression, hypertension, and acute coronary syndromes) that commonly affect older
adults and for which certain drugs may interact with opioids but where potentially safer alternatives are available.
The specific aims of this project are to evaluate whether: (1) SSRIs that inhibit 2D6 (fluoxetine, paroxetine)
increase rates of opioid-related emergency room visits and hospitalizations among older adults who use
oxycodone, hydrocodone, or tramadol; (2) calcium channel blockers (CCBs) that inhibit 3A4 (diltiazem,
verapamil) increase rates of opioid-related emergency room visits and hospitalizations among older adults who
use oxycodone, fentanyl, or tramadol; and (3) antiplatelet agents that inhibit 2B6...

## Key facts

- **NIH application ID:** 10034445
- **Project number:** 1R01HS027623-01
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Katsiaryna Bykov
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $399,999
- **Award type:** 1
- **Project period:** 2020-09-30 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10034445

## Citation

> US National Institutes of Health, RePORTER application 10034445, Drug interactions and opioid-related emergency room visits and hospitalizations among older adults (1R01HS027623-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10034445. Licensed CC0.

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