Association Between Opioid Analgesics and Suicide Attempts: A Nationwide French Case-Crossover Study.

IF 7.4 2区医学 Q1 CLINICAL NEUROLOGY

CNS drugs Pub Date : 2025-08-30 DOI:10.1007/s40263-025-01221-4

Bénédicte Nobile, Erika Nogue, M C Picot, Philippe Courtet, Chouki Chenaf, Nicolas Authier, Emilie Olié

{"title":"Association Between Opioid Analgesics and Suicide Attempts: A Nationwide French Case-Crossover Study.","authors":"Bénédicte Nobile, Erika Nogue, M C Picot, Philippe Courtet, Chouki Chenaf, Nicolas Authier, Emilie Olié","doi":"10.1007/s40263-025-01221-4","DOIUrl":null,"url":null,"abstract":"Background and objectives: The rising prescription rates and opioid-related harms in France highlight the need for local data. Evaluating this association may help identify vulnerable subgroups and guide safer prescribing practices. This study aimed to assess the association between opioid analgesic dispensation and the risk of suicide attempt in the French population. Secondary objectives included evaluation of a dose-response relationship and examination of the potential additive effects of co-prescriptions with benzodiazepines or gabapentinoids.Methods: We conducted a nationwide, population-based case-crossover study using data from the French National Health Insurance Database (Système National des Données de Santé, SNDS), covering 98.8% of the French population. Adults aged 18 years or older who were hospitalized for a first suicide attempt between 1 January 2013 and 31 December 2020, and who had received at least one opioid analgesic dispensation in the preceding year (excluding buprenorphine and methadone) were included. Opioid analgesic exposure during the 84 days before the attempt was compared with three earlier 84-day control periods.Results: Among 158,400 patients (mean age 47.0 years; 64.0% women), opioid analgesic dispensation was associated with a higher risk of suicide attempt (odds ratio [OR] = 1.26; 95% confidence interval 1.25-1.28). The risk was greater for strong opioid analgesics (OR = 1.73) and higher morphine-equivalent doses. Co-prescription with benzodiazepines or gabapentinoids further increased risk.Conclusions: Opioid analgesic use, especially at higher doses or in combination with benzodiazepines or gabapentinoids, was associated with an increased risk of suicide attempt. Clinical vigilance is warranted when prescribing these medications.Trial registration: NCT04211077, registered 3 January 2020 (retrospectively registered).","PeriodicalId":10508,"journal":{"name":"CNS drugs","volume":" ","pages":""},"PeriodicalIF":7.4000,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"CNS drugs","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s40263-025-01221-4","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and objectives: The rising prescription rates and opioid-related harms in France highlight the need for local data. Evaluating this association may help identify vulnerable subgroups and guide safer prescribing practices. This study aimed to assess the association between opioid analgesic dispensation and the risk of suicide attempt in the French population. Secondary objectives included evaluation of a dose-response relationship and examination of the potential additive effects of co-prescriptions with benzodiazepines or gabapentinoids.

Methods: We conducted a nationwide, population-based case-crossover study using data from the French National Health Insurance Database (Système National des Données de Santé, SNDS), covering 98.8% of the French population. Adults aged 18 years or older who were hospitalized for a first suicide attempt between 1 January 2013 and 31 December 2020, and who had received at least one opioid analgesic dispensation in the preceding year (excluding buprenorphine and methadone) were included. Opioid analgesic exposure during the 84 days before the attempt was compared with three earlier 84-day control periods.

Results: Among 158,400 patients (mean age 47.0 years; 64.0% women), opioid analgesic dispensation was associated with a higher risk of suicide attempt (odds ratio [OR] = 1.26; 95% confidence interval 1.25-1.28). The risk was greater for strong opioid analgesics (OR = 1.73) and higher morphine-equivalent doses. Co-prescription with benzodiazepines or gabapentinoids further increased risk.

Conclusions: Opioid analgesic use, especially at higher doses or in combination with benzodiazepines or gabapentinoids, was associated with an increased risk of suicide attempt. Clinical vigilance is warranted when prescribing these medications.

Trial registration: NCT04211077, registered 3 January 2020 (retrospectively registered).

查看原文本刊更多论文

阿片类镇痛药与自杀企图之间的关系：一项法国全国病例交叉研究。

背景和目标：法国不断上升的处方率和阿片类药物相关危害突出了对当地数据的需求。评估这种关联可能有助于确定易受伤害的亚群体，并指导更安全的处方实践。本研究旨在评估阿片类镇痛药分配与法国人群自杀企图风险之间的关系。次要目的包括评估剂量-反应关系和检查与苯二氮卓类药物或加巴喷丁类药物合用处方的潜在附加效应。方法：我们使用法国国家健康保险数据库（system National des donnsam， SNDS）的数据进行了一项全国性的、基于人群的病例交叉研究，覆盖了98.8%的法国人口。在2013年1月1日至2020年12月31日期间因首次自杀未遂住院并在前一年接受过至少一种阿片类镇痛药分配（不包括丁丙诺啡和美沙酮）的18岁或以上成年人被纳入研究对象。在尝试前84天的阿片类镇痛药物暴露与早期的三个84天对照期进行比较。结果：在158,400例患者（平均年龄47.0岁，64.0%为女性）中，阿片类镇痛药配药与自杀企图风险较高相关（优势比[OR] = 1.26； 95%可信区间1.25-1.28）。强阿片类镇痛药（OR = 1.73）和高吗啡当量剂量的风险更大。与苯二氮卓类药物或加巴喷丁类药物合用会进一步增加风险。结论：阿片类镇痛药的使用，特别是高剂量或与苯二氮卓类或加巴喷丁类药物联合使用，与自杀企图的风险增加有关。在处方这些药物时，临床警惕是有必要的。试验注册：NCT04211077，于2020年1月3日注册（回顾性注册）。

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

CNS drugs 医学-精神病学

CiteScore

12.00

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.