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2019 HSR&D/QUERI National Conference Abstract

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4099 — Past-Year Opioid Misuse is Linked to Past-Year Suicide Attempt in High Suicide-Risk Veterans

Lead/Presenter: Megan Chesin,  VA New Jersey Healthcare System
All Authors: Chesin MS (VA New Jersey Healthcare System), Interian A (VA New Jersey Healthcare System), Kline A (Rutgers-The State University of New Jersey, Robert Wood Johnson Medical School) St. Hill L (VA New Jersey Healthcare System) King A (VA New Jersey Healthcare System) Miller R (VA New Jersey Healthcare System) Latorre M (VA New Jersey Healthcare System) Stanley B (Columbia University College of Physicians & Surgeons; New York State Psychiatric Institute)

Objectives:
The main purpose of this study was to test the relationship between past-year suicide attempt (SA) and past-year opioid misuse among high suicide-risk Veterans. Our study addresses two HSRandD priorities, suicide prevention and opioids, and seeks to provide support to current VA opioid therapy guidelines [1], in which suicide risk assessment during opioid therapy is recommended.

Methods:
Data from 130 high suicide-risk Veteran patients were used. Sixty-four percent (n = 83) had made a past-year SA. Thirty-nine subjects (30%) endorsed using heroin, morphine illicitly, or misusing prescribed pain relievers in the past year, and were classified as past-year opioid misusers. Other subjects endorsed using alcohol or a drug other than opioids, in the past year, and were included in the control group. Chi-square analyses were used to compare past-year SA among past-year opioid misusers and controls. To test whether past-year opioid misuse remained significantly associated with past-year SA among Veterans when other factors linked to opioid misuse were controlled, we collected data on number of substances used in the past year and aggressive behavior, for example, and controlled for bivariate correlates of past-year opioid use in a multivariate logistic regression.

Results:
Past-year opioid misusers, compared to those who used at least one other illicit substance or alcohol in the past year, were more likely to have made a past-year SA (82.1% versus 56.0%; X2(1) = 8.0, p < .01; Cohen's h = .29). Lifetime aggressive behavior and the number of substances used in the past year were also greater among past-year opioid misusers. Past-year opioid misuse, but not lifetime aggressive behavior, remained associated with past-year SA in multivariate analysis (X2(2) = 11.1, p < .01, OR = 3.4).

Implications:
Our findings show a robust link between past-year SA and opioid misuse in Veterans.

Impacts:
SA and substance (mis-)use are significant problems among Veterans [2]. Our findings suggest Veterans endorsing recent opioid misuse are at particular risk for SA and should be assessed for SA risk. These findings have implications for VHA care, where several initiatives focus on opioid use and suicide prevention. The current results point to the value of aligning suicide prevention efforts within clinical programs that serve opioid use disorder patients.