Period of increased suicide risk after opioid cessation

1. Cessation of opioid treatment was associated a period of increased risk of overdose or suicide, with a positive association between risk and length of treatment prior to stopping.

Evidence Rating: 2 (Good)

In the past decade, significant efforts have been taken in North America to mitigate opioid prescription as a means to combat the opioid crisis and mitigate opioid use disorders and opioid related deaths. One of the safety concerns in question revolves around the cessation of treatment, as stopping opioid treatment was been found to be associated with suicidal thoughts, self-harm, and increased risk of hospitalization for an opioid-related event. To further characterize post-cessation risk, researchers conducted a retrospective study of 1,394,102 patients in the Veterans Health Administration with an outpatient opioid prescription, with the main outcome measures being suicide, overdose, and interaction with time of length of treatment. Of all patients examined, 799,668 (57.4%) had stopped opioid treatment, with variable rates of cessation depending on length of treatment. Stopping treatment was associated with an increased risk of overdose or suicide, with increased risk associated with longer duration of treatment. Hazard ratios for patients who stopped opioid treatment were 1.67 (for patients on treatment for 30 days or less), 2.80 (31-90 days), 3.95 (91-400 days), and 6.77 (>400 days). Other independent factors associated with greater risk of suicide or overdose included not being married, male sex, medical comorbidities, and prior diagnoses of mental health or substance use disorders. Rates were most pronounced immediately after treatment cessation, with decrease in incidence over three to 12 months. Data from this investigation reiterates the importance of placing patient safety at the forefront when prescribing opioids, and identifies several factors that clinicians should take into consideration to attenuate the risk of adverse outcomes when discontinuing the medication.

Click to read the study in BMJ

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