title: Opioid dose and risk of suicide.
abstract: Chronic pain is associated with increased risk of suicide, and opioids are commonly used to treat moderate to severe pain. However, the association between opioid dose and suicide mortality has not been examined closely. This retrospective data analysis described the risk of suicide associated with differing prescribed opioid doses. Data were from Veterans Affairs health care system treatment records and the National Death Index. Records analyzed were those of Veterans Affairs patients with chronic pain receiving opioids in fiscal years 2004 to 2005 (N = 123,946). Primary predictors were maximum prescribed morphine-equivalent daily opioid dose and opioid fill type. The main outcome measured was suicide death, by any mechanism, and intentional overdose death during 2004 to 2009. Controlling for demographic and clinical characteristics, higher prescribed opioid doses were associated with elevated suicide risk. Compared with those receiving ≤20 milligrams/day (mg/d), hazard ratios were 1.48 (95% confidence intervals [CI], 1.25-1.75) for 20 to <50 mg/d, 1.69 (95% CI, 1.33-2.14) for 50 to <100 mg/d, and 2.15 (95% CI, 1.64-2.81) for 100+ mg/d. The magnitude of association between opioid dose and suicide by intentional overdose was not substantially different from that observed for the overall measure of suicide mortality. Risk of suicide mortality was greater among individuals receiving higher doses of opioids, and treatment providers may want to view high opioid dose as a marker of elevated risk for suicide. Additional research is needed on opioid use, pain treatment, and suicide.
authors.affiliation: VA Serious Mental Illness Treatment Resource and Evaluation Center and VA Center for Clinical Management Research, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA Department of Veterans Affairs, HSR&D Center of Excellence, Indianapolis, IN, USA Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ilgen
authors.forename: Amy S B
authors.initials: ASB
authors.lastname: Bohnert
authors.forename: Dara
authors.initials: D
authors.lastname: Ganoczy
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bair
authors.forename: John F
authors.initials: JF
authors.lastname: McCarthy
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy* / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000209:etiology; D017063:Outcome Assessment, Health Care; D013405:Suicide / Q000523:psychology*; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D000701:Analgesics, Opioid