Veterans who take medications for opioid use disorder (OUD) for at least 15 days have more than a 50% decreased risk of dying by suicide compared with those not taking OUD medications, according to a study in the April issue of the American Journal of Psychiatry. Stable use of buprenorphine, in particular, was associated with a 66% reduced risk of suicide mortality compared with no buprenorphine use.
“These results again highlight the importance of providing medication treatment to as many people with opioid use disorder as possible,” wrote Bradley Watts, M.D., M.P.H., of the Geisel School of Medicine at Dartmouth College and colleagues. “Doing so may have broad impacts on health outcomes, including suicide mortality.”
Watts and colleagues analyzed data from the Department of Veterans Affairs (VA) and Centers for Medicare and Medicaid Services for 61,633 patients who received a medication for OUD (buprenorphine, methadone, or naltrexone) between 2003 and 2017. All the patients were tracked for up to five years after their first receipt of medication for OUD, their death, or the end of 2017. The patients were categorized into four groups based on their exposure to medication for OUD: those starting treatment (first 14 days on medication treatment), stopping treatment (first 14 days off medication treatment), stable in medication treatment (15+ days), and stable off medication treatment (15+ days).
Most of the patients were male (92.8%) and White (71.3%), with a mean age of 46.5 years. After adjusting for patient demographics, other mental and physical health diagnoses, and frequency of health care utilization, the researchers found that VA patients on stable medication treatment for OUD had a 55% reduced risk of suicide mortality, a 65% reduced risk of mortality by other external causes (such as an accident or injury), and a 66% reduced risk of death by any cause compared with those not taking medication for OUD. Patients just starting or stopping treatment had no differences in suicide mortality risk compared with those off medication.
When looking at individual OUD medications, Watts and colleagues found that stable buprenorphine use was associated with a reduced risk of death by suicide compared with no buprenorphine use. Methadone use was also associated with reduced suicide mortality, but when health care use and mental health diagnoses were factored in, the association of methadone with decreased risk was no longer significant. “This was largely because those who received methadone had far more mental health contacts,” Watts and colleagues wrote. Naltrexone was not associated with reduced suicide mortality risk in any analysis.
“This finding aligns with emerging evidence that buprenorphine may have rapid antisuicidal properties,” Watts and colleagues continued. “[B]uprenorphine’s unique opioid kappa receptor antagonist properties may be responsible for the effect. We also cannot rule out the possibility that buprenorphine and its associated treatment protocols in the United States are simply better tolerated than the other agents.”
In an accompanying editorial, Larissa J. Mooney, M.D., of the University of California, Los Angeles, wrote: “While the Watts et al. article is a worthwhile contribution to the literature on suicide among individuals with OUD, additional work is needed to delineate prevailing issues in broader samples (i.e., extending beyond the VA system) and in more recent times, considering the impacts of the COVID-19 pandemic, which may persist as factors in overdose and suicide.”
To read more on this topic, see the Psychiatric News article “OUD Overdose, Suicide Risk in Veterans Four Times Higher Without Buprenorphine.”
(Image: iStock/SARINYAPINNGAM)
APA to Launch New Version of Its Website on Thursday, April 7
Over the last two years, APA has worked on a major update of its website to improve its content, search engine, and accessibility for people with disabilities. In addition, the look of the website has been refreshed, and the main menu has been streamlined to reduce the number of “clicks” a user needs to find information.
Website traffic has grown tremendously over the last several years, driving the need to update the site. The number of pageviews has increased from 6.3 million in 2016 (the date of the last website redesign) to 40 million. The updated website will ensure that APA continues to respond to the expanding informational needs of members and provides accurate information about mental health to patients and families.