Prescription opioid and benzodiazepine misuse is associated with suicidal ideation in older adults

Abstract

Objectives: Suicide in older adults is a major public health issue. Past research across the US adult population has linked prescription medication misuse with suicidal ideation. No work has evaluated associations between prescription opioid or benzodiazepine misuse and suicidal ideation in older adults, and this work aimed to address that gap. Methods/Design: Data were from adults 50 years and older participating in the 2015-16 National Survey on Drug Use and Health (n = 17,608). Design-based logistic regression evaluated links between any past-year prescription opioid or benzodiazepine use without misuse or prescription misuse and past-year suicidal ideation, after controlling for sociodemographic, physical health, mental health and substance use correlates associated with suicidal ideation. Results: After controlling for all correlates, past-year use without misuse of prescription opioids or benzodiazepines were not associated with past-year suicidal ideation in older adults. In contrast, past-year opioid misuse (AOR = 1.84, 95% CI = 1.07-3.19) and benzodiazepine misuse (AOR = 2.00, 95% CI = 1.01-3.94) were significantly associated with past-year suicidal ideation, even after controlling for all covariates. While 2.2% of US older adults not engaged in either opioid or benzodiazepine misuse reported past-year suicidal ideation, 25.4% of those who misused both medication classes endorsed such suicidality (AOR = 4.73, 95% CI = 2.07-10.79). Conclusions: Both past-year prescription opioid and benzodiazepine misuse are associated with past-year suicidal ideation in US older adults. Clinicians encountering older adult patients at-risk for or engaged in prescription medication misuse also should screen for suicidality.

A comprehensive multivariate model of biopsychosocial factors associated with opioid misuse and use disorder in a 2017-2018 United States national survey

“…Other substance dependence or abuse has been associated with opioid misuse based on various risk factors. [11,25,30,45,52] In this study, we found that nicotine [25,26], alcohol [25,27], cocaine [52], methamphetamine [29], tranquilizers [31,32,53], other illicit stimulants [15], and marijuana [25] have a positive relationship with opioid misuse and use disorder. The stimulant effect from nicotine, cocaine, methamphetamine, and other illicit stimulants may mitigate the depressive effects of opioids and may increase the "high" effect.…”

A comprehensive multivariate model of biopsychosocial factors associated with opioid misuse and use disorder in a 2017-2018 United States national survey

“…Other substance dependence or abuse has been associated with opioid misuse based on varying risk factors. [13,28,33,47,50] In this study, we speci cally found that nicotine, [28,29] alcohol, [28,30] cocaine, [50] methamphetamine, [32] tranquilizers, [34,35,51] other illicit stimulants [20], and marijuana [28] have a positive relationship with opioid misuse and use disorder. The stimulant effect from nicotine, cocaine, methamphetamine, and other illicit stimulants have been stipulated to mitigate the depressive effects of opioids and may increase the "high" effect.…”

Prescription Tranquilizer/Sedative Sources for Misuse in Older Adults

“…When combined with the elevated rates of past-year opioid misuse in older adults using "physician sources only", though, reason for concern emerges. Previous work suggests that opioid and benzodiazepine misuse are each associated with an increased likelihood of suicidal ideation in older adults (Schepis, Simoni-Wastila, & McCabe, 2019). The high rates of older adult sedative/tranquilizer exposure (Maree et al, 2016) and significant misuserelated consequences indicate a need for careful screening and monitoring of older adults prescribed tranquilizer/sedative medications, as they may be more likely to experience suicidality and misuse opioid medication.…”