Suicide risk after abrupt discontinuation of long-term opioid therapy: an observational cohort study.

IF 3 3区 医学 Q1 ANESTHESIOLOGY
Pain Medicine Pub Date : 2025-10-01 DOI:10.1093/pm/pnaf044
Shu Huang, Tianze Jiao, Serena Jingchuan Guo, Jill A Star, Jiang Bian, Debbie L Wilson, Amie J Goodin
{"title":"Suicide risk after abrupt discontinuation of long-term opioid therapy: an observational cohort study.","authors":"Shu Huang, Tianze Jiao, Serena Jingchuan Guo, Jill A Star, Jiang Bian, Debbie L Wilson, Amie J Goodin","doi":"10.1093/pm/pnaf044","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>Centers for Disease Control and Prevention guidelines highlight the increased suicide risk associated with abrupt discontinuations of long-term opioid therapy (LTOT). However, evidence on specific dose and duration \"thresholds\" of LTOT for suicide risk is limited.</p><p><strong>Objective: </strong>We aimed to identify opioid dose trajectories before abrupt LTOT discontinuations and their association with 6-month suicide risk.</p><p><strong>Design: </strong>This retrospective cohort study analyzed 2016-2021 Florida Medicaid claims for adult non-cancer beneficiaries with abrupt LTOT discontinuation, defined as having a > 15-day gap in opioid supply after ≥90 consecutive days of use. We assessed prescription opioid doses as the mean weekly morphine-milligram equivalent (MME) 6 months preceding the first abrupt LTOT discontinuation. Group-based trajectory modeling identified distinct opioid trajectory patterns, and multivariable Cox proportional hazards models examined associations between trajectory groups and a composite outcome of suicidal ideation, non-fatal suicide attempts, and suicide death 6 months following the abrupt LTOT discontinuation.</p><p><strong>Results: </strong>Among 15 680 beneficiaries (mean age: 46.2 ± 11.1 years; 60.8% female), 4 trajectory groups based on weekly MMEs: Low (<25: n = 8814, 56.2%), moderate (25-50: n = 4313, 27.5%), high (51-150: n = 1452, 9.3%), and very-high (>150: n = 1101, 7.0%) were identified. Compared with the low-dose group, the very-high dose group had a significantly higher risk of suicide-related outcomes [adjusted hazard ratio (aHR): 2.2, 95% confidence interval (95%CI):1.3-3.6], while the moderate and high dose groups had similar risks (moderate: aHR = 1.3, 95%CI: 0.9-1.8, high: aHR = 0.7, 95%CI: 0.4-1.3).</p><p><strong>Conclusions: </strong>Among Florida Medicaid beneficiaries with LTOT, very-high opioid doses (>150 weekly MME) in the 6 months preceding an abrupt LTOT discontinuation were associated with an increased risk of suicide-related outcomes.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"631-642"},"PeriodicalIF":3.0000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pain Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/pm/pnaf044","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Importance: Centers for Disease Control and Prevention guidelines highlight the increased suicide risk associated with abrupt discontinuations of long-term opioid therapy (LTOT). However, evidence on specific dose and duration "thresholds" of LTOT for suicide risk is limited.

Objective: We aimed to identify opioid dose trajectories before abrupt LTOT discontinuations and their association with 6-month suicide risk.

Design: This retrospective cohort study analyzed 2016-2021 Florida Medicaid claims for adult non-cancer beneficiaries with abrupt LTOT discontinuation, defined as having a > 15-day gap in opioid supply after ≥90 consecutive days of use. We assessed prescription opioid doses as the mean weekly morphine-milligram equivalent (MME) 6 months preceding the first abrupt LTOT discontinuation. Group-based trajectory modeling identified distinct opioid trajectory patterns, and multivariable Cox proportional hazards models examined associations between trajectory groups and a composite outcome of suicidal ideation, non-fatal suicide attempts, and suicide death 6 months following the abrupt LTOT discontinuation.

Results: Among 15 680 beneficiaries (mean age: 46.2 ± 11.1 years; 60.8% female), 4 trajectory groups based on weekly MMEs: Low (<25: n = 8814, 56.2%), moderate (25-50: n = 4313, 27.5%), high (51-150: n = 1452, 9.3%), and very-high (>150: n = 1101, 7.0%) were identified. Compared with the low-dose group, the very-high dose group had a significantly higher risk of suicide-related outcomes [adjusted hazard ratio (aHR): 2.2, 95% confidence interval (95%CI):1.3-3.6], while the moderate and high dose groups had similar risks (moderate: aHR = 1.3, 95%CI: 0.9-1.8, high: aHR = 0.7, 95%CI: 0.4-1.3).

Conclusions: Among Florida Medicaid beneficiaries with LTOT, very-high opioid doses (>150 weekly MME) in the 6 months preceding an abrupt LTOT discontinuation were associated with an increased risk of suicide-related outcomes.

突然停止长期阿片类药物治疗后的自杀风险:一项观察性队列研究。
目的:美国疾病控制与预防中心(CDC)的指南强调,突然停止长期阿片类药物治疗(LTOT)会增加自杀风险。然而,关于ltt对自杀风险的特定剂量和持续时间“阈值”的证据有限。我们的目的是确定突然停药前阿片类药物的剂量轨迹及其与6个月自杀风险的关系。方法:本回顾性队列研究分析了2016-2021年佛罗里达州医疗补助计划(Florida Medicaid)中突然停用LTOT的成人非癌症受益人的索赔,定义为在连续使用≥90天后阿片类药物供应有100 - 15天的缺口。我们评估处方阿片类药物剂量为第一次突然停药前6个月的平均每周吗啡毫克当量(MME)。基于组的轨迹模型确定了不同的阿片类药物轨迹模式,多变量Cox比例风险模型检验了轨迹组与突然停药后6个月的自杀意念、非致命性自杀企图和自杀死亡的综合结果之间的关系。结果:15680名受益人(平均年龄:46.2±11.1岁;60.8%为女性),基于每周MMEs的4个轨迹组:低(150:n = 1101, 7.0%)。与低剂量组相比,极高剂量组自杀相关结局的风险显著升高[校正危险比(aHR): 2.2, 95%可信区间(95% ci):1.3-3.6],而中、高剂量组的风险相似(中度:aHR=1.3, 95% ci:0.9-1.8,高:aHR=0.7, 95% ci:0.4-1.3)。结论:在佛罗里达州接受LTOT的医疗补助受益人中,在突然停止LTOT之前的6个月内,非常高的阿片类药物剂量(每周150 MME)与自杀相关结果的风险增加有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Pain Medicine
Pain Medicine 医学-医学:内科
CiteScore
6.50
自引率
3.20%
发文量
187
审稿时长
3 months
期刊介绍: Pain Medicine is a multi-disciplinary journal dedicated to pain clinicians, educators and researchers with an interest in pain from various medical specialties such as pain medicine, anaesthesiology, family practice, internal medicine, neurology, neurological surgery, orthopaedic spine surgery, psychiatry, and rehabilitation medicine as well as related health disciplines such as psychology, neuroscience, nursing, nurse practitioner, physical therapy, and integrative health.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信