Pain medicine (Malden, Mass.) · 2025
Suicide risk after abrupt discontinuation of long-term opioid therapy: an observational cohort study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Huang Shu, Jiao Tianze, Guo Serena Jingchuan, Star Jill A, Bian Jiang, Wilson Debbie L, Goodin Amie J
Аннотация
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.
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.