Mixing Sedative-Hypnotics, Prescription Opioids Associated With Suicidal Ideation in Serious Mental Illness

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The investigators evaluated the frequency of concurrent use of sedative-hypnotic medications (clonazepam, temazepam, chlordiazepoxide, alprazolam) and opioids (morphine, oxycodone, buprenorphine).
The investigators evaluated the frequency of concurrent use of sedative-hypnotic medications (clonazepam, temazepam, chlordiazepoxide, alprazolam) and opioids (morphine, oxycodone, buprenorphine).

Concurrent use of sedative-hypnotic and prescription opioid medications may increase the risk for suicidal ideation in individuals with serious mental illness, according to a study published in Psychiatry Research.

Patients with serious mental illness were recruited from 2 urban psychiatry clinics (n=271). The investigators evaluated the frequency of concurrent use of sedative-hypnotic medications (clonazepam, temazepam, chlordiazepoxide, alprazolam) and opioids (morphine, oxycodone, buprenorphine) in this cohort.

Researchers assessed patients for polypharmacy (≥5 concurrent medications) and suicidal ideation, using the 24-item Behavior and Symptom Identification Scale (BASIS-24). In this cohort, 35 patients (13%) were taking an opioid medication and 42 patients (16%) were taking a sedative-hypnotic drug. Polypharmacy was reported by 96 patients (35%). There was a significant association between taking an opioid medication and having a history of heroin use (adjusted odds ratio [aOR], 4.12; 95% CI, 1.53-11.45; P =.005) and taking a prescribed sedative-hypnotic (aOR, 2.59; 95% CI, 1.03-6.50; P =.043).

Compared with patients not taking opiates, patients taking a prescribed opioid medication were also more likely to be on ≥5 concurrent medications (31.4% vs 62.9%, respectively; odds ratio [OR], 3.70; 95% CI, 1.77-7.76; P =.001) and to have visited the emergency department in the past 12 months (61.7% vs 85.7%, respectively; OR, 3.72; 95% CI, 1.39-9.95; P =.009). In addition, patients on opioid medications and sedative-hypnotics were more likely to report suicidal ideation in the past 7 days (aOR, 4.44; 95% CI, 1.09-18.04; P =.037).

The cross-sectional design of this study and reliance on self-reports could have limited causal inference and introduced recall and social desirability bias, respectively.

 “In a population with [serious mental illness], mixing [prescription opioids and sedative-hypnotics] may be particularly dangerous due to risk of intentional overdose,” concluded the study authors.

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Reference

Spivak S, Cullen B, Eaton W, et al. Prescription opioid use among individuals with serious mental illness. Psychiatry Res. 2018;267:85-87.

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