Michael I Demidenko1, Steven K Dobscha2, Benjamin J Morasco2, Thomas H A Meath3, Mark A Ilgen4, Travis I Lovejoy5. 1. VA Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, Mail Code: R&D 66, Portland, OR 97239, United States. 2. VA Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, Mail Code: R&D 66, Portland, OR 97239, United States; Department of Psychiatry, Oregon Health & Science University, 3181 SW U.S. Sam Jackson Park Road, Portland, OR 97239, United States. 3. VA Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, Mail Code: R&D 66, Portland, OR 97239, United States; Center for Health Systems Effectiveness, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: MDYCHSE, Portland, Oregon 97239, United States. 4. VA Center for Clinical Management Research, 2215 Fuller Road, VA Ann Arbor Health Care System, Ann Arbor, MI 48109, United States; Department of Psychiatry, University of Michigan, SPC 5763 2700, 4250 Plymouth Road, Ann Arbor, MI 48109, United States. 5. VA Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, Mail Code: R&D 66, Portland, OR 97239, United States; Department of Psychiatry, Oregon Health & Science University, 3181 SW U.S. Sam Jackson Park Road, Portland, OR 97239, United States; School of Public Health, Oregon Health & Science University, 3181 SW U.S. Sam Jackson Park Road, Mail Code: CB 669, Portland, OR 97239, United States. Electronic address: travis.lovejoy@va.gov.
Abstract
OBJECTIVE: Little is known about patient outcomes following discontinuation of opioid therapy, which may include suicidal ideation (SI) and suicidal self-directed violence (SSV). The purpose of this study was to examine correlates of SI and non-fatal SSV in a sample of patients discontinued from long-term opioid therapy (LTOT). METHOD: Five hundred-nine Veterans Health Administration (VHA) patients whose clinicians discontinued them from LTOT were selected from a national cohort of VHA patients who discontinued opioids in 2012. The sample comprised patients with a substance use disorder and matched controls. Patient electronic health records were manually reviewed to identify discontinuation reasons and the presence of SI or SSV in the 12months following discontinuation. RESULTS: Forty-seven patients (9.2%) had SI only, while 12 patients (2.4%) had SSV. In covariate-adjusted logistic regression models, mental health diagnoses associated with having SI/SSV included post-traumatic stress disorder (aOR=2.56, 95% CI=1.23-5.32) and psychotic disorders (aOR=3.19, 95% CI=1.14-8.89). Other medical comorbidities, substance use disorder and pain diagnoses, opioid dose, and benzodiazepine prescriptions were unrelated to SI/SSV. CONCLUSIONS: Among patients with a substance use disorder and matched controls, there are high rates of SI/SSV following opioid discontinuation, suggesting that these "high risk" patients may require close monitoring and risk prevention. Published by Elsevier Inc.
OBJECTIVE: Little is known about patient outcomes following discontinuation of opioid therapy, which may include suicidal ideation (SI) and suicidal self-directed violence (SSV). The purpose of this study was to examine correlates of SI and non-fatal SSV in a sample of patients discontinued from long-term opioid therapy (LTOT). METHOD: Five hundred-nine Veterans Health Administration (VHA) patients whose clinicians discontinued them from LTOT were selected from a national cohort of VHA patients who discontinued opioids in 2012. The sample comprised patients with a substance use disorder and matched controls. Patient electronic health records were manually reviewed to identify discontinuation reasons and the presence of SI or SSV in the 12months following discontinuation. RESULTS: Forty-seven patients (9.2%) had SI only, while 12 patients (2.4%) had SSV. In covariate-adjusted logistic regression models, mental health diagnoses associated with having SI/SSV included post-traumatic stress disorder (aOR=2.56, 95% CI=1.23-5.32) and psychotic disorders (aOR=3.19, 95% CI=1.14-8.89). Other medical comorbidities, substance use disorder and pain diagnoses, opioid dose, and benzodiazepine prescriptions were unrelated to SI/SSV. CONCLUSIONS: Among patients with a substance use disorder and matched controls, there are high rates of SI/SSV following opioid discontinuation, suggesting that these "high risk" patients may require close monitoring and risk prevention. Published by Elsevier Inc.
Authors: Jessica J Wyse; Benjamin J Morasco; Steven K Dobscha; Michael I Demidenko; Thomas H A Meath; Travis I Lovejoy Journal: J Opioid Manag Date: 2018 Jul/Aug