Opioid use disorders, psychiatric comorbidities, and risk for suicide attempts among veterans seeking pain care

Abstract

BackgroundThe purpose of this study was to assess the associations of comorbid opioid use disorders and psychiatric disorders with suicide attempts among veterans seeking pain care.MethodsThe cohort (N = 226 444) was selected by identifying pain care initiation from 2012 to 2014 using national Veterans Health Administration (VHA) data. Data on opioid use disorders (OUD), psychiatric disorders, medical comorbidity, demographics at baseline, and suicide attempts in the year following the initiation of pain care were extracted from VHA databases. Relative excess risk due to interaction (RERI) was used to assess departure from additivity of effects.ResultsAdjusted models indicated that both comorbid OUD and depression (RERI = 1.07) and comorbid OUD and AUD (RERI = 1.23) were significantly associated with additive risk of suicide attempt. In adjusted multiplicative interaction models, only comorbid OUD and bipolar disorder was significantly associated with suicide attempts; however, this association was protective (HR = 0.54).ConclusionsThe current findings highlight the importance of addressing opioid use disorders and alcohol use disorders and depression together to mitigate the risk of suicidal behavior.

Shared correlates of prescription drug misuse and severe suicide ideation among clinical patients at risk for suicide

“…Other studies showed higher doses of prescription opioid use are associated with suicide (Han et al, 2018;Ilgen et al, 2016). Ashrafioun and colleagues (2019) also discovered a similar finding that opioid use disorder along with depression or alcohol use disorder increased risk of suicide attempt among 226,444 Military Veterans seeking pain care (Ashrafioun et al, 2019). More research is needed to understand how prescription drug misuse and severe suicidal ideation are linked.…”

Analysis of nonfatal suicide attempts and demographic characteristics of US military veterans with opioid use disorder: A descriptive VA medical center study

“…Subsequently, within 365 days of the index visit, 15.6% of those with depression and 10.4% of those with PTSD attempted suicide. Our study's notably higher prevalence of PTSD diagnoses implies that the lifetime rates of these comorbid conditions are considerably greater 11 . Nevertheless, co‐morbid mental illness is a confounding factor, and the relationship between mental illness, OUD, and suicide attempts is very complex, and presence of any potentiate the risk of occurrence of the others.…”

“…Our study's notably higher prevalence of PTSD diagnoses implies that the lifetime rates of these comorbid conditions are considerably greater. 11 Nevertheless, co-morbid mental illness is a confounding factor, and the relationship between mental illness, OUD, and suicide attempts is very complex, and presence of any potentiate the risk of occurrence of the others. Which points to the need for addressing comorbid psychiatric conditions in this patient population.…”

Perspectives Regarding Medications for Opioid Use Disorder Among Individuals with Mental Illness

“…In Los Angeles County alone opioid overdoses increased by 467% from 2015 to 2020 (California Department of Public Health Substance and Addiction Prevention Branch). People with both mental illness and a substance use disorder (commonly referred to as a co-occurring disorder) are at greater risk for adverse OUD-related outcomes such as homelessness, incarceration, and suicide than those with only a single disorder (Ashrafioun et al, 2020 ; Manhapra et al, 2021 ; Winter et al, 2019 ). These individuals more often present and receive care in mental health systems rather than in addiction medicine clinics (Harris & Edlund, 2005 ; Simpson et al, 2020 ; Watkins et al, 2001 ), but unfortunately almost 80% of adults with co-occurring mental illness and OUD presenting to public mental health clinics have never received substance use treatment (Ober et al, 2021 ).…”