Mixing Sedative-Hypnotics, Prescription Opioids Associated With Suicidal Ideation in Serious Mental Illness
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.
Spivak S, Cullen B, Eaton W, et al. Prescription opioid use among individuals with serious mental illness. Psychiatry Res. 2018;267:85-87.