Association Between Opioid Prescribing and US Suicide Trends

A retrospective study of several US national databases published in the American Journal of Psychiatry has found that regional decreases in opioid prescribing were associated with fewer total suicide deaths.

One method to reduce suicide deaths is to decrease access to highly lethal methods of suicide. Opioids, the drug class that poses the greatest suicide risk, are associated with approximately 40% of overdose suicide deaths in the United States.

The current study was designed to assess whether reduction in opioid prescribing in the US was associated with a reduction in suicide deaths. Investigators sourced data for this study from the National Center for Health Statistics (for opioid-related mortality data), the IQVIA Longitudinal Prescription Database (for opioid prescription data), the US Department of Agriculture (USDA) (to identify geographic commuting zones or “regions” of population aggregation) and the US Census Bureau (to identify population-based rates of opioid prescribing and opioid-related mortality measures at the regional level). From January 2009 through December 2017, the following were related with total deaths by suicide: volume of opioid prescriptions filled per capita, percentage of individuals with at least 1 opioid prescription, percentage of high-dose prescriptions, percentage of long-term prescriptions, and percentage of individuals filling prescriptions from 3 or more prescribers per USDA-defined commuting zones.

All 5 opioid outcomes were declining during the study period, whereas deaths by suicide increased by 2.56 per 100,000 persons. The annual rate of suicides involving opioids did not change significantly during the study (difference, 0.02 per 100,000; P =.08).

All opioid outcomes were associated with total deaths by suicide (β range, 0.024-0.069; all P <.0001), suicides among boys or men (β range, 0.031-0.089; all P ≤.0001), and girls or women (β range, 0.037-0.057; all P <.0001). Stratified by age, the changes in the opioid outcomes tended to affect individuals aged 45-64 years more than other age groups.

Similar associations with the opioid outcomes were observed with overall deaths and gender-based trends for the subset of suicide deaths involving opioid overdose.

The investigators estimated that if there had not been a decreasing trend in opioid prescriptions, there would have been 3% more suicide deaths and 10.5% more opioid-related suicide deaths in 2017.

In general, the relationships between opioid prescribing, suicide deaths, and opioid-specific suicide deaths were stronger in the West, compared with the Midwest, East, or South.

In addition, unintentional deaths were associated with the change in opioid prescriptions per capita (β, 0.074; P =.007), as well as with the percentage of individuals with high-dose prescriptions (β, 0.050; P =.007). Undetermined deaths were associated with the change in opioid prescriptions per capita (β, 0.047; P =.002), the percentage of individuals with high-dose opioid prescriptions (β, 0.025; P =.004), the percentage with long-term opioid prescriptions (β, 0.036; P =.004), and the percentage with an opioid prescription from 3 or more prescribers (β, 0.024; P =.006).

This study had several limitations. First, it was not designed to evaluate causal relationships and should be interpreted as such. In addition, overdose events cannot be easily classified according to intent, particularly for fatal events. Furthermore, the study only examined available IQVIA data (which may not be complete) with regards to changes in prescribed opioids and did not focus on a means of measuring illicitly obtained opioids, which are involved in a large portion of overdose deaths. Finally, the researchers note that results from the study period may not be applicable to contemporary conditions.

The study authors concluded, “These findings reinforce the importance of safe opioid prescribing practices and proper disposal of unused opioids. In managing patients with pain, physicians should evaluate whether adequate relief can be achieved with [nonpharmacologic] interventions. While some patients with pain need and benefit from opioids without risk, those for whom opioids are prescribed should be evaluated and, if necessary, treated for co-occurring mental health disorders that might otherwise increase their risk of suicide.”

This article originally appeared on Psychiatry Advisor