Youth and young adults who start taking prescription opioids appear to have double the risk of suicidal behaviors compared with those who do not start taking prescription opioids, a report published Monday in Pediatrics suggests. However, when comparing suicidal behaviors in youth initiating prescription opioids with those initiating prescription nonsteroidal anti-inflammatory drugs (NSAIDs), there appeared to only be a modest association between opioid initiation and suicidal behavior.
“These results are consistent with the hypothesis that confounding from preexisting factors associated with pain indications, rather than opioid initiation itself, drives much of the observed risk of suicidal behavior among opioid initiators,” wrote Kimberly L. Fine, Ph.D., of Indiana University and colleagues.
For the study, Fine and colleagues analyzed Swedish population-register data on nearly 1.9 million individuals aged 9 to 29 years for whom there was no record of prior opioid prescriptions. They tracked prescriptions dispensed to these youth and young adults beginning in January 2007 and diagnosed self-injurious behavior and death by suicide through December 2013. Of these individuals, 201,433 individuals (10.6%) began taking an opioid prescription during the study period. (Prescriptions for codeine and tramadol comprised more than 75% of these prescriptions.)
Youth and young adults who initiated prescription opioids had more than double the risk of suicidal behavior relative to young people who did not initiate prescription opioids: 2.9% of initiators experienced at least some suicidal behavior within five years, compared with 1.2% of those who did not begin taking these medications.
The researchers next compared suicidal behavior in 86,635 young people who initiated prescription opioids with 255,096 young people who initiated prescription NSAIDs. The incidence of suicidal behavior within five years was 2.2% for opioid initiators and 1.9% for NSAID initiators. “[O]pioid initiators had 19% relatively greater adjusted risk of suicidal behavior than did prescription NSAID initiators. Although this association was statistically significant, it was small, corresponding to 3 additional opioid initiators per 1,000 experiencing suicidal behavior within five years.”
While “the results cannot definitively establish the magnitude of a potential influence of opioid initiation, they suggest that any increase in risk of suicidal behavior is unlikely to be large, and decisions to initiate opioid prescription should consider the full range of potential benefits as well as harms,” the authors concluded.
For related information, see the Psychiatric News article “Psychiatrists Need to Be Prepared to Support Patients in Pain.”
(Image: iStock/Brian)
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