How opioid prescriptions and suicide rates are linked

The study can help medical experts understand the risks of opioids.

ISLAMAABAD, (Online) - New research study has found that in areas where prescriptions of opioids have decreased, the rates of suicide were also impacted and were not as high as expected.

The study, published this week in the American Journal of Psychiatry, comes as opioid-related overdoses have reached record highs.

The author of the study, and professor of psychiatry and epidemiology at Columbia University, Dr. Mark Olfson (MD, MPH), said the study can help medical experts understand the risks of opioids and think bout how to prescribe pills safely.

“On the one hand, what these results, from a clinical perspective suggest, is that they underscore safety risks of opioids, and they reinforce the importance of safe and judicious prescribing of opioids and proper disposal of unused opioids,” Olfson said. “In managing patients with pain, It’s important that healthcare professionals consider whether adequate pain relief can be achieved with interventions first that don’t involve medications.”

More suicides may have occurred if opioids had continued to be commonly prescribed

Rather than looking at individualized data, the researchers focused on broader trends gleaned from national database data held by IQVIA alongside mortality statistics from the National Center for Health Statistics.

The team looked at data from 2009 to 2017. During that time they looked at rates of opioid prescriptions, rates specifically for high-dose opioids, and for the number of long-term prescriptions. Additionally they looked to see what the rate was of having multiple opioid prescribers.

They found during the study period there was a downward trend for all of factors.

While the rate of suicide deaths did increase during this period from 13.80 to 16.36 per 100,000 persons, the researchers say that it would have been even higher if opioid prescriptions were as high in 2017 as they were in 2009.

“If opioid prescribing per capita had held constant from 2009 to 2017, there would have been an estimated 10.5% more suicide deaths involving opioids in 2017,” Olfson said in a statement.

How chronic pain can lead to suicide risk

For Dr. Steven Siwek, founder of the Pain Center of Arizona, seeing patients who are grappling with issues related to mental health and suicide, alongside their use of opioids, is a common theme.

“Hopelessness is something that I see every day…and without the hope of stable pain control, without the hope of some level of someone listening, and addressing, and finding some component that allows these patients stable pain control, better level of functioning, and better quality of life, that hopelessness can spiral very quickly.”

He says that, for many of these patients, using opioids and other medications isn’t about eradicating their pain completely, but about reducing it and improving their quality of life. His hope is that this study reinforces for clinicians that the link is there between suicide risk and opioid use and that it leads medical providers to dedicate more time and resources towards interventions for chronic pain that don’t include opioids.

“I will tell you that we are looking harder than ever at interventional therapies and minimally invasive surgeries now as tools and options to solve pathology rather than simply, ‘here’s a medication that will make you feel better without fixing the underlying problem.”

The more prescriptions the higher the risk

One finding of the study was that the more opioid prescribers a person has, the more risk they are at. The study found that those with three or more opioid prescribers were at higher risk for suicide. Peter Piraino (LMSW. LCDC) of Burning Tree says that in his work with those recovering from addiction, he’s seen a shift from what’s known as “doctor shopping.”

“We used to see people come to the door with 10, 12, 13 doctors. A lot of the states in the US now have databases that don’t allow a person to do that. So what we see now is more people just come in on fentanyl… but when doctor shopping was prevalent, yes, we would see people with a minimum of three doctors. Like, that was a light day for them.”

The research found that if the rate of people with more than one opioid prescriber had held steady in 2017 there would have been an estimated 19% more opioid-related suicide deaths.

How to reduce risk of suicide

Piraino is mindful of the divide that is forming when it comes to what might be viewed as the best way to treat those in need of opiates.

“You have two very polarizing points of view. Either there’s not enough opioids and people are killing themselves; or, there’s too many opioids and people are killing themselves. My hope would be that we take a better look at the data, and even do longitudinal studies going forward… and find out out how to reduce suicide.”

For Michelle Sproule (MSc, LPC), chief clinical officer at Scottsdale Recovery Center, the focus is on meeting clients where they are at when they hit their “rock bottom” rather than being stubbornly prescriptive about what approach might be best.

“Because if we’re not looking at the whole person, and what’s going to impact them directly and just saying, ‘Well, this is what works for these people in general,’ then we’re not taking into account socioeconomic status, we’re not taking into account resources, we’re not taking into account, maybe, some of the cultural aspects that might be impacting them,” Sproule said. “And that is a disservice to the community. There’s no way that we can do that effectively and actually try to beat this thing.”