Julian Santaella-Tenorio1, Silvia S Martins1, Magdalena Cerdá2, Mark Olfson1,3,4, Katherine M Keyes1,5. 1. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA. 2. Center for Opioid Epidemiology and Policy, NYU Grossman School of Medicine, NYU, New York, NY. 3. Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA. 4. New York State Psychiatric Institute, New York, New York, USA. 5. Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile.
Abstract
BACKGROUND: Since 1999, the rate of fatal prescription opioid overdoses and of suicides has dramatically increased in the USA. These increases, which have occurred among similar demographic groups, have led to the hypothesis that the opioid epidemic contributed to increases in suicidal behavior, though the underlying association remains poorly defined. We examine the association between nonmedical use of prescription opioids/opioid use disorder and suicidal ideation/attempts. METHODS: We used longitudinal data from a national representative sample of the US adult population, the National Epidemiologic Survey on Alcohol and Related Conditions. Participants (n = 34 653) were interviewed in 2001-2002 (wave 1) and re-interviewed approximately 3 years later (wave 2). A propensity score analysis estimated the association between exposure to prescription opioids at wave 1 and prevalent/incident suicidal behavior at wave 2. RESULTS: Heavy/frequent (⩾2-3 times a month) prescription opioid use was associated with prevalent suicide attempts [adjusted risk ratio (ARR) = 2.75, 95% CI 1.35-5.60]. Prescription opioid use disorder was associated with prevalent (ARR = 1.98, 95% CI 1.20-3.28) and incident suicidal ideation (ARR = 2.59, 95% CI 1.25-5.37), and prevalent attempts (ARR = 4.19, 95% CI 1.71-10.27). None of the exposures was associated with incident suicide attempts. CONCLUSIONS: Heavy/frequent opioid use and related disorder were associated with prevalent suicide attempts; opioid use disorder was also associated with the incident and prevalent suicidal ideation. Given population increases in nonmedical use of prescription opioids and disorder, the opioid crisis may have contributed to population increases in suicidal ideation.
BACKGROUND: Since 1999, the rate of fatal prescription opioid overdoses and of suicides has dramatically increased in the USA. These increases, which have occurred among similar demographic groups, have led to the hypothesis that the opioid epidemic contributed to increases in suicidal behavior, though the underlying association remains poorly defined. We examine the association between nonmedical use of prescription opioids/opioid use disorder and suicidal ideation/attempts. METHODS: We used longitudinal data from a national representative sample of the US adult population, the National Epidemiologic Survey on Alcohol and Related Conditions. Participants (n = 34 653) were interviewed in 2001-2002 (wave 1) and re-interviewed approximately 3 years later (wave 2). A propensity score analysis estimated the association between exposure to prescription opioids at wave 1 and prevalent/incident suicidal behavior at wave 2. RESULTS: Heavy/frequent (⩾2-3 times a month) prescription opioid use was associated with prevalent suicide attempts [adjusted risk ratio (ARR) = 2.75, 95% CI 1.35-5.60]. Prescription opioid use disorder was associated with prevalent (ARR = 1.98, 95% CI 1.20-3.28) and incident suicidal ideation (ARR = 2.59, 95% CI 1.25-5.37), and prevalent attempts (ARR = 4.19, 95% CI 1.71-10.27). None of the exposures was associated with incident suicide attempts. CONCLUSIONS: Heavy/frequent opioid use and related disorder were associated with prevalent suicide attempts; opioid use disorder was also associated with the incident and prevalent suicidal ideation. Given population increases in nonmedical use of prescription opioids and disorder, the opioid crisis may have contributed to population increases in suicidal ideation.
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