Yasmina Molero1, Johan Zetterqvist1, Ingrid A Binswanger1, Clara Hellner1, Henrik Larsson1, Seena Fazel1. 1. From the Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan, Stockholm; the Institute for Health Research, Kaiser Permanente Colorado, Denver; the Division of General Internal Medicine, University of Colorado School of Medicine, Aurora; and the School of Medical Sciences, Örebro University, Örebro, Sweden.
Abstract
OBJECTIVE: The authors examined associations between medications for alcohol and opioid use disorders (acamprosate, naltrexone, methadone, and buprenorphine) and suicidal behavior, accidental overdoses, and crime. METHOD: In this total population cohort study, 21,281 individuals who received treatment with at least one of the four medications between 2005 and 2013 were identified. Data on medication use and outcomes were collected from Swedish population-based registers. A within-individual design (using stratified Cox proportional hazards regression models) was used to compare rates of suicidal behavior, accidental overdoses, and crime for the same individuals during the period when they were receiving the medication compared with the period when they were not. RESULTS: No significant associations with any of the primary outcomes were found for acamprosate. For naltrexone, there was a reduction in the hazard ratio for accidental overdoses during periods when individuals received treatment compared with periods when they did not (hazard ratio=0.82, 95% CI=0.70, 0.96). Buprenorphine was associated with reduced arrest rates for all crime categories (i.e., violent, nonviolent, and substance-related) as well as reduction in accidental overdoses (hazard ratio=0.75, 95% CI=0.60, 0.93). For methadone, there were significant reductions in the rate of suicidal behaviors (hazard ratio=0.60, 95% CI=0.40-0.88) as well as reductions in all crime categories. However, there was an increased risk for accidental overdoses among individuals taking methadone (hazard ratio=1.25, 95% CI=1.13, 1.38). CONCLUSIONS: Medications currently used to treat alcohol and opioid use disorders also appear to reduce suicidality and crime during treatment.
OBJECTIVE: The authors examined associations between medications for alcohol and opioid use disorders (acamprosate, naltrexone, methadone, and buprenorphine) and suicidal behavior, accidental overdoses, and crime. METHOD: In this total population cohort study, 21,281 individuals who received treatment with at least one of the four medications between 2005 and 2013 were identified. Data on medication use and outcomes were collected from Swedish population-based registers. A within-individual design (using stratified Cox proportional hazards regression models) was used to compare rates of suicidal behavior, accidental overdoses, and crime for the same individuals during the period when they were receiving the medication compared with the period when they were not. RESULTS: No significant associations with any of the primary outcomes were found for acamprosate. For naltrexone, there was a reduction in the hazard ratio for accidental overdoses during periods when individuals received treatment compared with periods when they did not (hazard ratio=0.82, 95% CI=0.70, 0.96). Buprenorphine was associated with reduced arrest rates for all crime categories (i.e., violent, nonviolent, and substance-related) as well as reduction in accidental overdoses (hazard ratio=0.75, 95% CI=0.60, 0.93). For methadone, there were significant reductions in the rate of suicidal behaviors (hazard ratio=0.60, 95% CI=0.40-0.88) as well as reductions in all crime categories. However, there was an increased risk for accidental overdoses among individuals taking methadone (hazard ratio=1.25, 95% CI=1.13, 1.38). CONCLUSIONS: Medications currently used to treat alcohol and opioid use disorders also appear to reduce suicidality and crime during treatment.
Entities:
Keywords:
Alcohol Abuse; Epidemiology; Psychoactive Substance Use Disorder; Suicide; Violence/Aggression
Authors: Louisa Degenhardt; Chiara Bucello; Bianca Calabria; Paul Nelson; Anna Roberts; Wayne Hall; Michael Lynskey; Lucas Wiessing; Maria Elena Medina Mora; Nico Clark; Johanna Thomas; Christina Briegleb; Jennifer McLaren Journal: Drug Alcohol Depend Date: 2011-03-05 Impact factor: 4.492
Authors: Deborah M Stone; Kristin M Holland; Brad Bartholow; Joseph E Logan; Wendy LiKamWa McIntosh; Aimee Trudeau; Ian R H Rockett Journal: Am J Public Health Date: 2017-06-22 Impact factor: 9.308
Authors: Gil Zalsman; Keith Hawton; Danuta Wasserman; Kees van Heeringen; Ella Arensman; Marco Sarchiapone; Vladimir Carli; Cyril Höschl; Ran Barzilay; Judit Balazs; György Purebl; Jean Pierre Kahn; Pilar Alejandra Sáiz; Cendrine Bursztein Lipsicas; Julio Bobes; Doina Cozman; Ulrich Hegerl; Joseph Zohar Journal: Lancet Psychiatry Date: 2016-06-08 Impact factor: 27.083
Authors: Brittany B Dennis; Pavel S Roshanov; Leen Naji; Monica Bawor; James Paul; Carolyn Plater; Guillaume Pare; Andrew Worster; Michael Varenbut; Jeff Daiter; David C Marsh; Dipika Desai; Zainab Samaan; Lehana Thabane Journal: Trials Date: 2015-10-21 Impact factor: 2.279
Authors: Madeline C Frost; Julie E Richards; John R Blosnich; Eric J Hawkins; Judith I Tsui; E Jennifer Edelman; Emily C Williams Journal: Drug Alcohol Depend Date: 2022-06-03 Impact factor: 4.852
Authors: Hilary S Connery; Roger D Weiss; Margaret L Griffin; Catherine D Trinh; Jungjin Kim; Ian R H Rockett; R Kathryn McHugh Journal: Drug Alcohol Depend Date: 2022-04-02 Impact factor: 4.852
Authors: Kathryn Hawk; Lauretta E Grau; David A Fiellin; Marek Chawarski; Patrick G O'Connor; Nikolas Cirillo; Chris Breen; Gail D'Onofrio Journal: Acad Emerg Med Date: 2021-02-28 Impact factor: 3.451
Authors: Yasmina Molero; Andrea Cipriani; Henrik Larsson; Paul Lichtenstein; Brian M D'Onofrio; Seena Fazel Journal: Lancet Psychiatry Date: 2020-11 Impact factor: 27.083