Clinical Perspective on Opioids in the Context of Suicide Risk

Abstract

Psychiatrists are on the front lines of two simultaneous public health crises: the increasing rates of suicide and opioid-related deaths. In this review, the authors discuss ways in which these two classes of preventable deaths may be linked, with an emphasis on identifying and preventing both outcomes through increased understanding of their shared risk factors. As clinicians, it is crucial to maintain awareness of the ways in which opioid use may contribute to depression and suicidality, as well as how mood disorders may complicate opioid use. In light of this interplay, interventions which target risk factors for both suicide and overdose are key. Interventions include early treatment of substance dependence and depression, as well as harm reduction measures, such as provision of naloxone, medication-assisted treatments for dependency, and multidisciplinary approaches to chronic pain that do not rely solely on escalating opioid doses. It is also important to address social determinants of health, which may increase risk for both accidental and intentional overdose. The roads to overdose and suicide overlap considerably and cannot be considered separately.

Prevalence of suicidal behavior in patients with chronic pain: a systematic review and meta-analysis of observational studies

“…Considering the association between chronic pain and suicide ( Hooley et al, 2014 ; Hooten, 2016 ; Racine, 2018 ), the management of chronic pain may be considered for the purpose of reducing the risk of SB in individuals with SB. However, as the use of opioids may contribute to SB in individuals with chronic pain in the context of suicide risk, non-pharmacological therapies may be advantageous for the treatment of chronic pain in these patients ( Nestadt and Bohnert, 2020 ). Promising non-pharmacological therapies include cognitive behavioral therapy, which is commonly used for chronic pain and suicide prevention ( Stanley et al, 2009 ).…”

“…For example, "+ § §" means that two regression analyses, adjusting for psychiatric symptoms, reported statistically significant associations with a higher risk of suicidal behavior. suicide risk, non-pharmacological therapies may be advantageous for the treatment of chronic pain in these patients (Nestadt and Bohnert, 2020). Promising non-pharmacological therapies include cognitive behavioral therapy, which is commonly used for chronic pain and suicide prevention (Stanley et al, 2009).…”