Study Shows Past Year Opioid Misuse Associated with Past-Year Suicide Attempt among High-Risk Veterans
Among VA patients, greater opioid use and opioid misuse increase the long-term risk of suicide – beyond the risk conferred by other factors, including psychiatric and other substance use disorders. Whether rates of suicide attempt by overdose differ among patients who use different types of substances (i.e., misuse opioids versus other substances) â€“ or whether suicide attempt risk is greater among different types of past-year opioid misusers (i.e., those who misuse prescription pain relievers, morphine, or heroin) is unclear. The main objective of this study was to test the relationship between past-year suicide attempt and past-year opioid misuse among Veterans at high risk of suicide who also reported using at least one illicit substance or alcohol in the past year. The second objective was to test whether the relationship between past-year opioid misuse and past-year suicide attempt would persist in the context of known psychosocial factors associated with opioid misuse and suicide attempt, such as major depressive disorder, co-occurring misuse of other substances, impulsivity, aggressive behavior, and pain catastrophizing. Investigators analyzed baseline data from 130 high suicide-risk Veterans (n=39 past-year opioid misusers; n=91 past-year users of other substances) who enrolled in a randomized controlled trial testing adjunctive mindfulness-based cognitive therapy to prevent suicidal behavior. Participants had been admitted to two acute VAMC psychiatry inpatient units for suicide risk between December 2013 and April 2018. Information was collected using a semi-structured interview.
- Past-year opioid misuse was associated with past-year, but not lifetime, suicide attempt in high suicide-risk Veterans: 82% of opioid misusers had attempted suicide in the past year versus 56% of those who misused other substances.
- The relationship between past-year opioid misuse and past-year suicide attempt remained significant when psychosocial factors associated with suicide attempt and opioid misuse were included as covariates.
- Suicide attempt rates did not differ among those who misused different types of opioids. Among Veterans with past-year suicide attempt, those who misused opioids in the past year were more likely to use overdose as a method to attempt suicide compared to those who misused other substances.
- Opioid misuse may be a marker of more lethal near-term suicide behavior. Thus, findings provide support for current VA opioid therapy guidelines (VA/DoD Opioid Therapy for Chronic Pain, 2017), in which suicide risk assessment during opioid therapy is recommended. Lethal means restriction of toxic substances among Veteran opioid misusers also may be important.
- Findings may not be generalizable to Veterans who are not at high risk for suicide.
This study was funded by HSR&D (IIR 12-134). Dr. Interian is part of the VA New Jersey Health Care System.
Chesin M, Interian A, Kline A, et al. Past-Year Opioid Misuse and Suicide Attempt are Positively Associated in High Suicide Risk Veterans Who Endorse Past-Year Substance Use. Addictive Behaviors. December 2019;99:106064.