Suicidal ideation and suicide attempt across stages of nonmedical prescription opioid use and presence of prescription opioid disorders among U.S. adults

Prevalence and Correlates of Opioid-Involved Suicides in Maryland

OBJECTIVE

Involvement of opioids in suicides has doubled during the past two decades, worsening a major public health concern. This study examined the characteristics of opioid-involved suicides.

METHODS

The sample of decedents (N = 12,038) in Maryland between 2006 and 2020 was used to compare the characteristics of opioid-involved suicides (n = 947) with suicides not involving opioids (n = 6,896) and accidental opioid deaths (n = 4,125). Direct comparisons were then made between opioid-involved suicides with and without the additional presence of non-opioid substances.

RESULTS

Opioid-involved suicides were significantly more likely than suicides not involving opioids to occur among those aged 18-64 years, non-Hispanic Whites, and unemployed or disabled individuals. Opioid-involved suicides were more likely than accidental opioid deaths to occur among females, those aged <18 years, non-Hispanic Whites, and employed individuals. Of all suicides involved opioids, 45% involved other non-opioid substances. Polysubstance opioid suicides were significantly more likely than suicides involving opioids only to occur among non-Hispanic Whites.

CONCLUSIONS

Significant differences were observed in the demographic groups most at risk for opioid-involved suicide than other suicide or accidental opioid death. Among opioid-involved suicides, polysubstance involvement also represents a distinct group. These findings may enhance the targeting of prevention efforts.

Prenatal opioid use as a predictor of postpartum suicide attempts among reproductive-age women enrolled in Oregon Medicaid

BACKGROUND

The rates of suicide and opioid use disorder (OUD) among pregnant and postpartum women continue to increase. This research characterized OUD and suicide attempts among Medicaid-enrolled perinatal women and examined prenatal OUD diagnosis as a marker for postpartum suicide attempts.

METHODS

Data from Oregon birth certificates, Medicaid eligibility and claims files, and hospital discharge records were linked and analyzed. The sample included Oregon Medicaid women aged 15-44 who became pregnant and gave live births between January 2008 and January 2016 (N = 61,481). Key measures included indicators of suicide attempts (separately for any means and opioid poisoning) and OUD diagnosis, separately assessed during pregnancy and the one-year postpartum period. Probit regression was used to examine the overall relationship between prenatal OUD diagnosis and postpartum suicide attempts. A simultaneous equations model was employed to explore the link between prenatal OUD diagnosis and postpartum suicide attempts, mediated by postpartum OUD diagnosis.

RESULTS

Thirty-three prenatal suicide attempts by any means were identified. Postpartum suicide attempts were more frequent with 58 attempts, corresponding to a rate of 94.3 attempts per 100,000. Of these attempts, 79% (46 attempts) involved opioid poisoning. A total of 1,799 unique women (4.6% of the sample) were diagnosed with OUD either during pregnancy or one-year postpartum with 53% receiving the diagnosis postpartum. Postpartum suicide attempts by opioid poisoning increased from 55.5 per 100,000 in 2009 to 105.1 per 100,000 in 2016. The rate of prenatal OUD also almost doubled over the same period. Prenatal OUD diagnosis was associated with a 0.15%-point increase in the probability of suicide attempts by opioid poisoning within the first year postpartum. This increase reflects a three-fold increase compared to the rate for women without a prenatal OUD diagnosis. A prenatal OUD diagnosis was significantly associated with an elevated risk of postpartum suicide attempts by opioid poisoning via a postpartum OUD diagnosis.

CONCLUSIONS

The risk of suicide attempt by opioid poisoning is elevated for Medicaid-enrolled reproductive-age women during pregnancy and postpartum. Women diagnosed with prenatal OUD may face an increased risk of postpartum suicides attempts involving opioid poisoning.

Principal component regression analysis of familial psychiatric histories and suicide risk factors among adults with opioid use disorder

This study explores familial psychiatric risk factors that are closely linked to suicide risk among patients with opioid use disorder (OUD) as measured by the Family History Assessment Module (FHAM). Data was derived from adults diagnosed with OUD (N = 389). To analyze the covariance between the 11 items of the FHAM, principal component analysis was applied to infer principal components (PC) scores. Log-binominal regression was conducted to quantify the associations between PC scores and mental health symptoms (e.g., lifetime suicidal attempt, P30D suicidal ideation, depression, and anxiety). Analyses revealed that the first 3 three PCs could account for 56% of the total variance of the FHAM items within the data. Family history of substance misuse (PC1) was positively associated with lifetime suicide attempts and severe anxiety. Family history of serious mental illness (PC2) and of suicidal behavior (PC3) were not significantly associated with any outcomes. Our findings suggest current suicide risk is associated with an array of familial psychiatric issues among people with OUD. However, family history of suicide attempts and death by suicide has less bearing on current suicide risk in OUD patients whereas family history of substance use confers significant risk. Findings underscore suicide-related preventive interventions as necessary components of treatment plans among people with OUD, who commonly report family histories of substance misuse.

A National Retrospective Study of Antidepressants' Effects on Overdose and Self-Harm Among Adults Treated With Opioid Analgesics

OBJECTIVE

Because individuals with a history of depression who are receiving opioids are at higher risk for adverse events, the authors examined whether antidepressant treatment reduces risk for overdose and self-harm among individuals with a history of depression who receive opioids.

METHODS

Commercial insurance claims of individuals with a history of depression receiving opioids from 2007 to 2017 were used to quantify the association between antidepressant fills and adverse events among individuals after initiation of opioid treatment; the authors accounted for selection into treatment and used discrete-time, proportional hazards survival models.

RESULTS

Among 283,374 adults with a history of depression treatment, 8,203 experienced 47,486 adverse events from 2007 to 2017 in the 12 months after initiation of opioid treatment. Approximately half (N=144,052, 50.8%) filled an antidepressant prescription at least once in the 12 months after the opioid episode began. Individuals receiving antidepressants for at least 6 weeks had a reduced risk for any adverse event (adjusted odds ratio [AOR]=0.79, 95% confidence interval [CI]=0.65-0.97) as well as a reduced risk for opioid overdoses (AOR=0.78, 95% CI=0.64-0.96), overdoses from nonopioid controlled substances (AOR=0.76, 95% CI=0.62-0.94), overdoses from other substances (AOR=0.79, 95% CI=0.65-0.97), and other self-harm events (AOR=0.82, 95% CI=0.67-1.00).

CONCLUSIONS

Individuals with a history of depression who received opioid analgesics had a significantly lower risk for overdose and self-harm after they had been taking antidepressants for at least 6 weeks. Universal screening for mood disorders among individuals receiving opioids, and promptly providing evidence-based depression treatment when appropriate, may reduce adverse events.

Substance use disorders and social determinants of health from electronic medical records obtained during Kentucky's "triple wave"

Social determinants of health (SDOH) play a critical role in the risk of harmful drug use. Examining SDOH as a means of differentiating populations with multiple co-occurring substance use disorders (SUDs) is particularly salient in the era of prevalent opioid and stimulant use known as the "Third Wave". This study uses electronic medical records (EMRs) from a safety net hospital system from 14,032 patients in Kentucky from 2017 to 2019 in order to 1) define three types of SUD cohorts with shared/unique risk factors, 2) identify patients with unstable housing using novel methods for EMRs and 3) link patients to their residential neighborhood to obtain quantitative perspective on social vulnerability. We identified patients in three cohorts with statistically significant unique risk factors that included race, biological sex, insurance type, smoking status, and urban/rural residential location. Adjusting for these variables, we found a statistically significant, increasing risk gradient for patients experiencing unstable housing by cohort type: opioid-only (n = 7385, reference), stimulant-only (n = 4794, odds ratio (aOR) 1.86 95 % confidence interval (CI): 1.66-2.09), and co-diagnosed (n = 1853, aOR = 2.75, 95 % CI: 2.39 to 3.16). At the neighborhood-level, we used 8 different measures of social vulnerability and found that, for the most part, increasing proportions of patients with stimulant use living in a census tract was associated with more social vulnerability. Our study identifies potentially modifiable factors that can be tailored by substance type and demonstrates robust use of EMRs to meet national goals of enhancing research on social determinants of health.

Differences in overdose deaths by intent: Unintentional & suicide drug poisonings in North Carolina, 2015-2019

Comprehensive fatal overdose prevention requires an understanding of the fundamental causes and context surrounding drug overdose. Using a social determinants of health (SDOH) framework, this descriptive study examined unintentional and self-inflicted (i.e., suicide) overdose deaths in North Carolina (NC), focusing on specific drug involvement and contextual factors. Unintentional and suicide overdose deaths were identified using 2015-2019 NC death certificate data. Specific drug involvement was assessed by searching literal text fields for drug mentions. County-level contextual factors were obtained from NC Institute of Medicine and County Health Rankings, encompassing five SDOH domains (economic stability, social/community context, health care access/quality, education access/quality, neighborhood/built environment). Descriptive statistics were calculated by intent for drug involvement and a variety of contextual factors. During 2015-2019, 9% of NC drug overdose deaths were self-inflicted and 89% were unintentional (2% other/undetermined). Unintentional overdoses largely involved illicit drugs [fentanyl (47%), cocaine (33%), heroin (29%)]. Suicide overdoses frequently involved prescription opioids [oxycodone (18%), hydrocodone (10%)] and antidepressants (32%). Overall, overdose deaths tended to occur in under-resourced counties across all SDOH domains, though unintentional overdoses occurred more often among residents of under-resourced counties than suicide overdoses, with differences most pronounced for economic stability-related factors. There are notable distinctions between unintentional and suicide overdose deaths in demographics and drug involvement, though the assessment of SDOH demonstrated that overdose mortality is broadly associated with marginalization across all domains. These findings highlight the value of allocating resources to prevention and intervention approaches that target upstream causes of overdose (e.g., housing first, violence prevention programs).

The association of prescription opioid use with suicide attempts: An analysis of statewide medical claims data

Background

Suicides and opioid overdose deaths are among the most pressing public health concerns in the US. However direct evidence for the association between opioid use and suicidal behavior is limited. The objective of this article is to examine the association between frequency and dose of prescription opioid use and subsequent suicide attempts.

Methods and findings

This retrospective cohort study analyzed 4 years of statewide medical claims data from the Connecticut All-Payer Claims Database. Commercially insured adult patients in Connecticut (n = 842,773) who had any medical claims beginning in January 2012 were followed through December 2015. The primary outcome was suicide attempt identified using International Classification of Diseases (ICD 9) diagnosis codes. Primary predictor variables included frequency of opioid use, which was defined as the number of months with claims for prescription opioids per year, and strength of opioid dose, which was standardized using morphine milligram equivalent (MME) units. We also controlled for psychiatric and medical comorbidities using ICD 9 codes. We used Cox proportional hazards regression to examine the association between frequency, dose, and suicide attempts, adjusting for medical and psychiatric comorbid conditions. Interactions among measures of opioid use and comorbid conditions were analyzed.

In this cohort study with follow-up time up to 4 years (range = 2–48 months, median = 46 months), the hazard ratios (HR) from the time-to-event analysis indicated that patients prescribed opioid medications for at least 6 months during the past year and at 20–50 MME levels or higher had 4.44 (95% CI: [3.71, 5.32]) to 7.23 (95% CI: [6.22, 8.41]) times the risk of attempted suicide compared to those not prescribed opioids. Risk of suicide attempt was sharply elevated among patients with psychiatric conditions other than anxiety who were prescribed more frequent and higher opioid doses. In contrast, more frequent and higher doses of prescription opioids were associated with lower risk of suicide attempts among patients with medical conditions necessitating pain management.

This study is limited by its exclusive focus on commercially insured patients and does not include patients covered by public insurance. It is also limited to patients’ receipt of prescription opioids and does not take into account opioids obtained through other means, nor does it include measures of actual patient opioid use.

Conclusions

This analysis provides evidence of a complex relationship among prescription opioids, mental health, pain and other medical comorbidities, and suicide risk. Findings indicate the need for proactive suicide surveillance among individuals diagnosed with affective or psychotic disorders who are receiving frequent and high doses of opioids. However, appropriate opioid treatment may have significant value in reducing suicide risk for those without psychiatric comorbidities.

Large-Scale Social Media Analysis Reveals Emotions Associated with Nonmedical Prescription Drug Use

Background

The behaviors and emotions associated with and reasons for nonmedical prescription drug use (NMPDU) are not well-captured through traditional instruments such as surveys and insurance claims. Publicly available NMPDU-related posts on social media can potentially be leveraged to study these aspects unobtrusively and at scale.

Methods

We applied a machine learning classifier to detect self-reports of NMPDU on Twitter and extracted all public posts of the associated users. We analyzed approximately 137 million posts from 87,718 Twitter users in terms of expressed emotions, sentiments, concerns, and possible reasons for NMPDU via natural language processing.

Results

Users in the NMPDU group express more negative emotions and less positive emotions, more concerns about family, the past, and body, and less concerns related to work, leisure, home, money, religion, health, and achievement compared to a control group (i.e., users who never reported NMPDU). NMPDU posts tend to be highly polarized, indicating potential emotional triggers. Gender-specific analyses show that female users in the NMPDU group express more content related to positive emotions, anticipation, sadness, joy, concerns about family, friends, home, health, and the past, and less about anger than males. The findings are consistent across distinct prescription drug categories (opioids, benzodiazepines, stimulants, and polysubstance).

Conclusion

Our analyses of large-scale data show that substantial differences exist between the texts of the posts from users who self-report NMPDU on Twitter and those who do not, and between males and females who report NMPDU. Our findings can enrich our understanding of NMPDU and the population involved.

Health harms of non-medical prescription opioid use: A systematic review

ISSUES

Non-medical prescription opioid use (NMPOU) contributes substantially to the global burden of morbidity. However, no systematic assessment of the scientific literature on the associations between NMPOU and health outcomes has yet been undertaken.

APPROACH

We undertook a systematic review evaluating health outcomes related to NMPOU based on ICD-10 clinical domains. We searched 13 electronic databases for original research articles until 1 July 2021. We employed an adaptation of the Oxford Centre for Evidence-Based Medicine 'Levels of Evidence' scale to assess study quality.

KEY FINDINGS

Overall, 182 studies were included. The evidence base was largest on the association between NMPOU and mental and behavioural disorders; 71% (129) studies reported on these outcomes. Less evidence exists on the association of NMPOU with infectious disease outcomes (26; 14%), and on external causes of morbidity and mortality, with 13 (7%) studies assessing its association with intentional self-harm and 1 study assessing its association with assault (<1%).

IMPLICATIONS

A large body of evidence has identified associations between NMPOU and opioid use disorder as well as on fatal and non-fatal overdose. We found equivocal evidence on the association between NMPOU and the acquisition of HIV, hepatitis C and other infectious diseases. We identified weak evidence regarding the potential association between NMPOU and intentional self-harm, suicidal ideation and assault.

DISCUSSION AND CONCLUSIONS

Findings may inform the prevention of harms associated with NMPOU, although higher-quality research is needed to characterise the association between NMPOU and the full spectrum of physical and mental health disorders.

Race Differences in Opioid Misuse and Adolescent Suicidality

PURPOSE

The rise of the opioid epidemic coincided with the increased risk of suicide as the leading causes of death among adolescents in the United States. Past research has linked non-medical prescription opioid use (NMPOU) with adolescent suicide. Less focus has been placed on race and ethnic differences among adolescents impacted by the opioid epidemic. This study examined the relationship of adolescent NMPOU and suicidality, stratified by race.

METHOD

The 2016 National Survey on Drug Use and Health (NSDUH) was used for this study. Weighted multivariate logistic regression analyses were conducted on a sample of 11,489 adolescent respondents to examine the effect of past-year NMPOU with the odds for serious thoughts of suicide, having a suicide plan, and making a suicide attempt.

RESULTS

Findings indicated a higher prevalence of suicidality among adolescents who engaged in NMPOU compared to non-users. Adolescent opioid misuse was associated with 68% higher odds for having a suicide plan in the past year (OR = 1.68, 95% CI: [1.07, 2.63], p < 0.05). Interaction analysis found that among Asian adolescents, NMPOU was associated with higher odds for having a suicide plan compared to other race groups (OR=1.53, 95% CI: [1.04, 2.23], p < 0.05).

DISCUSSION

Results indicated that adolescent opioid misuse is a risk factor for suicide, and Asians compared to other race groups were at greater risk. Social workers can serve as a nexus point in effectively engaging at-risk adolescents in substance use and mental health prevention and recovery services.

Nonmedical Prescription Drug Use Among Female Adolescents: The Relative Influence of Maternal Factors, Social Norms, and Perceptions of Risk and Availability

Increasing understanding of the risk and protective factors for adolescent nonmedical use of prescription drugs (NMUPD) could inform prevention efforts. Several correlates have been identified, including parental factors, perceptions about use and accessibility, social norms, and age. However, these constructs have rarely been simultaneously examined using paired data from parents and adolescents. We aimed to examine the relative influence of these correlates among dyads (N=349) of mothers and adolescent daughters. Using multiple logistic regression, daughters' past NMUPD and inclination for future NMUPD were regressed onto descriptive norms for friend use, perceived drug accessibility and risk of harm from use, daughter age, mothers' disapproval about use, mothers' past NMUPD and inclination for future NMUPD, and the mother-daughter relationship quality. Akaike weights and lasso regressions were also estimated to evaluate the relative importance of each correlate. Higher descriptive norms for friend use, older age, and mothers' inclination for NMUPD were risk factors for daughters' NMUPD, while a closer mother-daughter relationship and mothers' disapproving attitudes towards NMUPD were protective factors. The three analysis approaches were corroborative. Results suggest friend descriptive norms, mother-daughter relationship quality, and mothers' attitudes about NMUPD are important prevention targets.

Suicidal ideation and attempts following nonmedical use of prescription opioids and related disorder

BACKGROUND

Since 1999, the rate of fatal prescription opioid overdoses and of suicides has dramatically increased in the USA. These increases, which have occurred among similar demographic groups, have led to the hypothesis that the opioid epidemic contributed to increases in suicidal behavior, though the underlying association remains poorly defined. We examine the association between nonmedical use of prescription opioids/opioid use disorder and suicidal ideation/attempts.

METHODS

We used longitudinal data from a national representative sample of the US adult population, the National Epidemiologic Survey on Alcohol and Related Conditions. Participants (n = 34 653) were interviewed in 2001-2002 (wave 1) and re-interviewed approximately 3 years later (wave 2). A propensity score analysis estimated the association between exposure to prescription opioids at wave 1 and prevalent/incident suicidal behavior at wave 2.

RESULTS

Heavy/frequent (⩾2-3 times a month) prescription opioid use was associated with prevalent suicide attempts [adjusted risk ratio (ARR) = 2.75, 95% CI 1.35-5.60]. Prescription opioid use disorder was associated with prevalent (ARR = 1.98, 95% CI 1.20-3.28) and incident suicidal ideation (ARR = 2.59, 95% CI 1.25-5.37), and prevalent attempts (ARR = 4.19, 95% CI 1.71-10.27). None of the exposures was associated with incident suicide attempts.

CONCLUSIONS

Heavy/frequent opioid use and related disorder were associated with prevalent suicide attempts; opioid use disorder was also associated with the incident and prevalent suicidal ideation. Given population increases in nonmedical use of prescription opioids and disorder, the opioid crisis may have contributed to population increases in suicidal ideation.

Frequency and recency of non-medical opioid use and death due to overdose or suicide among individuals assessed for risky substance use: A national registry study in Sweden

Sweden and many other countries have experienced increases in suicide and accidental overdose deaths. An analysis examined the associations between recency of non-medical opioid misuse and frequency of use of non-medical opioids with death due to either suicide or accidental overdose within a sample of 15,000 Swedish adults who completed an Addiction Severity Index (ASI) assessment for risky substance use or a substance use disorder.

METHODS AND MATERIALS

Suicide (n = 136) and death due to overdose (n = 405) were identified in the official Cause of Death Registry from the Swedish National Board of Health and Welfare. Control variables included demographic characteristics and risks associated with either overdose or suicide. Cox regression analyses controlled for variables statistically significantly at the bivariate level.

RESULTS

At the multivariable level: a) a higher (modified) ASI Composite Score for mental health; b) history of suicide attempt; c) having used non-medical opioids for 1-2 times per week for at least a year; d) history of injection drug use; and, e) early onset of drug use, were all significantly and positively associated with death due to suicide. At the multivariable level: a) a higher the revised ASI Composite Score for mental health; b) recency of use of non-medical opioids; c) frequency of non-medical opioid use; d) being a male; and e) being of ages 18-24 years compared to ages 43-51 years were all positively and significantly associated with death due to accidental overdose.

CONCLUSION

These findings underscore the need to integrate mental health and substance use disorder treatment and provide suicide and overdose prevention interventions for individuals with an opioid use disorder. Recency and frequency of non-medical opioids were only associated with death due to overdose and not suicide. However, other drug use related variables (using opioids 1-2 times per week for at least a year, early onset of drug use and drug injection) were significantly associated with death due to suicide.

A cross sectional study of non-medical use of prescription opioids and suicidal behaviors among adolescents

Background

Non-medical use of prescription opioids (NMUPO), defined as taking an opioid in a manner or dose other than prescribed, taking someone else’s, or for the feelings that it produces, has been reported by 5 to 20% of adolescents, and is associated with a two fold increase in suicidal behaviors among adolescents. Adolescents with long-term health problems (LTHP) have poorer mental health and may seek NMUPO for pain relief that is not obtained through standard care. For this study, we measured the association between NMUPO and suicidal behaviors, and further assessed effect modification by LTHP hypothesizing the association between NMUPO and suicidal behaviors was stronger for adolescents with LTHP.

Findings

For students with LTHP, 13.5% reported suicide ideation, while 8.0% of students without LTHP reported suicide ideation. For suicide attempt, 4.4% of students with LTHP reported a suicide attempt, while 2.1% of students without LTHP reported a suicide attempt. The proportion of students who reported suicide ideation and attempts increased with higher occasions of NMUPO. Adjusted logistic regression models found increased odds of suicide ideation (OR (95% CI): 1–5 occasions: 2.3 (2.0–2.6); > 6 occasions: 2.7 (2.2–3.8)) and suicide attempts (OR (95% CI): 1–5 occasions: 3.2 (2.7–3.7); > 6 occasions: 4.1 (3.1–5.3)) for students who reported NMUPO. An interaction term for NMUPO and LTHP was then added to the models. Effect modification was not present on the multiplicative scale. On the additive scale, evidence of effect modification was observed: higher risk was indicated for students with LTHP versus no LTHP for both suicide ideation (Predicted risk (95%CI): > 6 occasions NMUPO, LTHP: 0.24 (0.18–0.29); No LTHP: 0.16 (0.13–0.18)) and attempt (Predicted risk (95%CI): 1–5 occasions NMUPO, LTHP: 0.08 (0.07–0.10); No LTHP: 0.05 (0.05–0.06); > 6 occasions NMUPO, LTHP: 0.11 (0.07–0.15); No LTHP: 0.06 (0.05–0.08)).

Conclusions

The results affirmed that NMUPO is associated with suicidal behaviors among adolescents. A pattern also emerged of higher risk of suicidal behaviors for those with LTHP who reported NMUPO. Areas of further inquiry should explore chronic medical or pain conditions as possible modifying pathways that could exacerbate the effects of NMUPO on suicidal behaviors specific to an adolescent population.

Number of opioid overdoses and depression as a predictor of suicidal thoughts

BACKGROUND

Opioid use disorders are associated with increased risk of suicide thoughts, attempts, and death. We explored key variables from two theories of the development of suicidal thoughts and attempts (the interpersonal and three-step theories of suicide) to understand possible mechanisms underlying the association between opioid use and suicide risk. We hypothesized that interpersonal connections, variables reflecting psychological and physical pain, and variables that reduce fear of death (prior overdoses and risk-taking behaviors) would be associated with increased risk of thoughts of suicide.

METHODS

Participants (N = 141) were opioid users recruited from an epicenter of the opioid crisis in Philadelphia using a mobile research center and completed an interview to assess substance use, depression, medical comorbidities, and suicidal thoughts among other variables.

RESULTS

Univariate analyses showed that prior history of overdose, diagnosis of depression, older age, homelessness, and interpersonal connection were each associated with increased likelihood of endorsing thoughts of death/suicide. Multivariable analyses revealed prior history of overdose and depression were the variables most strongly associated with risk for thoughts of suicide.

CONCLUSIONS

Consistent with two theories of the development of suicidal thoughts and attempts, exposure to variables that reduce fear of death (e.g., overdoses) were associated with suicidal thoughts. In contrast, other risk-taking behaviors, medical comorbidities, and substance use were not key predictors of suicidal thoughts in this sample. Implications for targeted risk assessment among clinicians are discussed.

Current Prescription Opioid Misuse and Suicide Risk Behaviors Among High School Students

BACKGROUND AND OBJECTIVES

In previous studies, researchers have reported that youth with a lifetime history of prescription opioid misuse (POM) are at an increased risk for suicidal ideation, planning, and attempts. In this study, we investigate whether the association between youth POM and suicide outcomes differs by recency of POM (ie, none, past, or current misuse).

METHODS

In this report, we use data from the 2019 Youth Risk Behavior Survey to examine associations between recency of POM (current POM, past POM, and no POM) and suicide risk behaviors among US high school students.

RESULTS

After controlling for demographics, alcohol, and other drug use, both current POM and past POM were significantly associated with all suicide risk behaviors compared with no POM. Students who reported current POM had the highest adjusted prevalence ratios (aPRs) for suicidal ideation (aPR: 2.30; 95% confidence interval [CI] 1.97-2.69), planning (aPR: 2.33; 95% CI 1.99-2.79), attempts (aPR: 3.21; 95% CI 2.56-4.02), and feeling sad or hopeless (aPR: 1.59; 95% CI 1.37-1.84). Students who reported current POM also were significantly more likely than youth who reported past POM to report that they had seriously considered attempting suicide, made a suicide plan, and attempted suicide.

CONCLUSIONS

Although POM, particularly current POM, is associated with increases in the risk for suicide-related behaviors and experiences of youth, comprehensive prevention approaches that address the intersections between suicide and POM provide a promising path forward for addressing these public health challenges among youth.

Case Series of Patients with Opioid Use Disorder and Suicidal Ideation Treated with Buprenorphine

Introduction

Buprenorphine benefits patients with opioid use disorder (OUD) in the emergency department (ED), but its efficacy for OUD patients with suicidal ideation (SI) in the ED is unknown.

Case Series

We present a case series of 14 OUD patients with SI who were given buprenorphine and a referral to outpatient substance use treatment in the ED. All experienced SI resolution, engaged with outpatient services, and remained in outpatient substance use treatment 30 days after ED discharge.

Conclusion

Our data provide evidence for the feasibility of starting buprenorphine in OUD patients with SI in the ED, and suggest that buprenorphine may be useful in helping to resolve SI for these patients. Future research with larger samples is needed.

Gender differences in the relationship between prescription opioid misuse and depressive symptoms and suicidality among US High School Students

BACKGROUND

Prescription opioid misuse and suicide among adolescents are significant health challenges.

PURPOSE

This study investigated whether effects of prescription opioid misuse on depressive symptoms and suicidality are greater among female than male students.

METHODS

Using the 2017 Youth Risk Behavior Survey (N = 14,765), this research estimated additive interactions using risk differences as well as multiplicative interactions using odds ratios.

DISCUSSION

Results showed prescription opioid misuse was associated with significantly greater risks among females than males for depressive symptoms (31.1% vs. 20.8%), suicidal ideation (27.3% vs. 19.1%), suicide attempts (18.1% vs. 11.9%) and suicide attempts requiring treatment (8.5% vs. 4.4%). In contrast, multiplicative interactions using odds ratios were all nonsignificant.

CONCLUSIONS

Among students who misused prescription opioids, females compared to males had much higher average predicted margins of depressive symptoms, suicidal ideation, suicide attempts, and suicide attempts requiring treatment. Screening for depression and suicidality among adolescents who misuse prescription opioids, and vice versa, is paramount.

Identifying risk factors for suicidal ideation across a large community healthcare system

BACKGROUND

Suicide is the tenth leading cause of death in the United States. Several studies have leveraged electronic health record (EHR) data to predict suicide risk in veteran and military samples; however, few studies have investigated suicide risk factors in a large-scale community health population.

METHODS

Clinical data was queried for 9,811 patients from the Penn Medicine Health System who had completed a Patient Health Questionnaire-9 (PHQ-9) documented in the EHR between January 2017 and June 2019. Patient demographics, PHQ-9 scores, and psychiatric comorbidities were extracted from the EHR. Univariate and multivariable logistic regressions were applied to determine significant risk factors associated with suicide ideation responses from the PHQ-9.

RESULTS

One-quarter (25.8%% of patients endorsed suicide ideation. Univariate analysis found 22 risk factors of suicide ideation. Multivariable logistic regression found significant positive associations (Odds Ratio, (95% Confidence Interval)) with the following: younger ages less than 18 years: 2.1, (1.69, 2.60) and 19-24 years: 1.55, (1.29, 1.87)), single marital status (1.22, (1.08, 1.38)), African American (1.22, (1.08, 1.38)), non-commercial insurance (1.16, (1.03, 1.31)), multiple comorbidities (1 comorbidity (1.65, (1.32, 2.07); 2 comorbidities (2.07, (1.61, 2.64)), 3+ comorbidities (2.49, (1.87, 3.33))), bipolar disorders (Type I: 1.38, (1.14, 1.67) and Type II: 1.94, (1.52, 2.49)), depressive disorders (1.70, (1.49, 1.94)), obsessive compulsive disorder (OCD) (1.43, (1.08, 1.90)), and stress disorders (1.53, (1.33, 1.76)).

CONCLUSION

Community EHR information can be used to predict suicidal ideation. This information can be used to design tools for identifying patients at risk for suicide in real-time.

Disparities in Prescription Opioid Misuse Affecting Sexual Minority Adults Are Attenuated by Depression and Suicidal Ideation

Purpose: Heightened rates of prescription opioid misuse have been observed among sexual minority (SM) compared with heterosexual populations. In addition, depression and suicidal ideation are risk factors for misuse, and they are also elevated among SM populations. The purpose of this analysis was to examine whether depression and suicidal ideation attenuate disparities in prescription opioid misuse among SM adults. Methods: Data came from a publicly available, nationally representative data set, the National Survey on Drug Use and Health, 2015-2018. Among adults, survey-weighted logistic regression was used to assess the relationship between sexual orientation and past-year opioid misuse adjusting for demographics and either past-year major depressive episode or suicidal ideation. Probabilities of prescription opioid misuse were also assessed under counterfactual rates of depression and suicidal ideation. Analyses were stratified by sex. Results: Among participants in the analytic sample (N = 169,759; SM = 11,268), 9254 (5.5%) reported past-year prescription opioid misuse. The overall rate of opioid misuse decreased from 6.2% in 2015 to 4.6% in 2018. The association between sexual orientation and opioid misuse was attenuated downward for gay men, lesbian women, and bisexual individuals (men and women) after adjusting for either major depressive episode or suicidal ideation, but opioid misuse remained higher among most SM groups. In addition, rates of opioid misuse were found to be lower in counterfactual analyses with a nearly 2.5- and 4-fold decrease in depression and suicidal ideation among gay men and bisexual women, respectively. Conclusion: Efforts to reduce disparities in depression and suicidal ideation affecting SM individuals may reduce disparities in prescription opioid misuse affecting this population.

Prescription Drug Misuse: Taking a Lifespan Perspective

Prescription drug misuse (PDM), or medication use without a prescription or in ways not intended by the prescriber, is a notable public health concern, especially in the United States. Accumulating research has characterized PDM prevalence and processes, but age-based or lifespan changes in PDM are understudied. Given age-based differences in the medical or developmental concerns that often underlie PDM, it is likely that PDM varies by age. This review summarizes the literature on PDM across the lifespan, examining lifespan changes in prevalence, sources, motives and correlates for opioid, stimulant, and tranquilizer/sedative (or benzodiazepine) PDM. In all, prevalence rates, sources and motives vary considerably by age group, with fewer age-based differences in correlates or risk factors. PDM prevalence rates tend to decline with aging, with greater use of physician sources and greater endorsement of self-treatment motives in older groups. Recreational motives (such as to get high) tend to peak in young adulthood, with greater use of peer sources or purchases to obtain medication for PDM in younger groups. PDM co-occurs with other substance use and psychopathology, including suicidality, across age groups. The evidence for lifespan variation in PDM is strongest for opioid PDM, with a need for more research on tranquilizer/sedative and stimulant PDM. The current literature is limited by the few studies of lifespan changes in PDM within a single sample, a lack of longitudinal research, little research addressing PDM in the context of polysubstance use, and little research on minority groups, such as sexual and gender minorities.

Age Differences in Non-Medical Prescription Opioid Use and Psychological Distress

Background/Purpose: Prescription opioid use has been recognized as an epidemic in the United States and globally. More research is needed to understand the association of opioids and mental health for older adults. This study examined age differences in the association of non-medical prescription opioid use (NMPOU) and psychological distress, with a focus on older adult populations. Methods: This study used the 2016 National Survey on Drug Use and Health (NSDUH), and included 37,842 adults aged 18 and older. Weighted multiple regression and logistic regression analyses were used to examine the association of NMPOU and psychological distress, measured by the Kessler Psychological Distress Scale (K6). Results: NMPOU was associated with higher psychological distress (b = 0.48, SE = 0.16, p < .01). For those 50 and older, NMPOU was associated with 224% increased odds of meeting the clinical threshold for having a serious mental illness (SMI; OR = 2.24, p < .01, 95% CI: 1.23, 4.09). Conclusions: Although the prevalence of NMPOU and psychological distress trended downward throughout the lifespan, the association of NMPOU on SMI was highest among the youngest and oldest adults. These findings highlight the need for services and supports that are tailored for older adult populations. Future research is needed to investigate vulnerabilities from life stage stressors specific to older adults, which may account for the disproportionate odds of opioid use on mental health pathology. Interprofessional collaboration is needed among geriatric professionals to provide effective mental health treatment for this at-risk population.

Attenuation of antidepressant and antisuicidal effects of ketamine by opioid receptor antagonism

We recently reported that naltrexone blocks antidepressant effects of ketamine in humans, indicating that antidepressant effects of ketamine require opioid receptor activation. However, it is unknown if opioid receptors are also involved in ketamine's antisuicidality effects. Here, in a secondary analysis of our recent clinical trial, we test whether naltrexone attenuates antisuicidality effects of ketamine. Participants were pretreated with naltrexone or placebo prior to intravenous ketamine in a double-blinded crossover design. Suicidality was measured with the Hamilton Depression Rating Scale item 3, Montgomery-Åsberg Depression Rating Scale item 10, and Columbia Suicide Severity Rating Scale. In the 12 participants who completed naltrexone and placebo conditions, naltrexone attenuated the antisuicidality effects of ketamine on all three suicidality scales/subscales (linear mixed model, fixed pretreatment effect, p < 0.01). Results indicate that opioid receptor activation plays a significant role in the antisuicidality effects of ketamine.

Past-year opioid misuse and suicide attempt are positively associated in high suicide risk veterans who endorse past- year substance use

The main purpose of this study was to test the relationship between past-year suicide attempt (SA) and past-year opioid misuse among Veterans at high risk of suicide who reported using at least one illicit substance or alcohol in the past year. Baseline data from 130 high suicide-risk Veterans (n = 39 past-year opioid misusers; n = 91 past-year users of other substances) who enrolled in a randomized controlled trial testing adjunctive Mindfulness-Based Cognitive Therapy to Prevent Suicidal Behavior were used. Information was collected on a semi-structured interview that included the Columbia-Suicide Severity Rating Scale to collect suicide attempt history. Past-year opioid misusers, compared to those who used at least one other illicit substance or alcohol in the past year, were more likely to have made a past-year SA. Past-year opioid misuse remained associated with past-year SA in multivariate analysis that included other known risk factors for SA. Our findings show a robust link between near-term SA and opioid misuse in Veterans.

The Role of Opioid Use in Distinguishing between Suicidal Ideation and Attempts

OBJECTIVE

Opioid use disorders are associated with heightened suicidal ideation, suicide attempts, and suicide death. This study aimed to examine the extent to which opioid differentiates between those with suicide attempts from those with lifetime suicidal ideation but no history of attempt.

METHODS

Participants were drawn from the US National Guard and a residential substance use treatment facility. Multinomial logistic regression was utilized to determine the extent to which a lifetime history of nonmedical opioid use differentiated between (1) individuals with no lifetime history of suicidal ideation or attempt, (2) individuals with a history of suicidal ideation but no attempt, and (3) individuals with a history of at least one suicide attempt.

RESULTS

History of opioid use among National Guard personnel and opioid use disorders among substance-dependent patients were associated with an increased likelihood of having at least one suicide attempt relative to both a history of suicidal ideation but no attempts and no history of ideation or attempts. Findings held when accounting for lifetime nonmedical use of other substances and the presence of other lifetime substance use disorders.

CONCLUSIONS

Results highlight the importance of assessing for suicide risk among opioid users.

Interactive effects of PTSD and substance use on suicidal ideation and behavior in military personnel: Increased risk from marijuana use

BACKGROUND

The current study examines the unique and interactive effects of posttraumatic stress disorder (PTSD) symptoms and days using alcohol, opioids, and marijuana on PTSD symptoms, suicidal ideation, and suicidal behavior up to 1 year, later in a high-risk sample of military personnel not active in mental health treatment.

METHODS

Current and former military personnel at risk for suicide (N = 545; M age = 31.91 years, standard deviation = 7.27; 88.2% male) completed self-report measures of PTSD symptoms, past 30 days heavy alcohol use, opioid use, marijuana use, and current suicidal ideation via telephone at baseline and 1, 3, 6, and 12 months later. PTSD symptoms and the substance use variables (and relevant covariates) were entered as predictors of changes in PTSD symptoms, the likelihood of suicidal ideation, suicidal ideation severity, and the likelihood of suicidal behavior during the 11-month follow-up period.

RESULTS

PTSD symptoms predicted PTSD symptoms 1 month later. PTSD symptoms and marijuana use predicted the likelihood of suicidal ideation 1 month later and suicidal behavior during the 11-month follow-up period. The interaction between PTSD symptoms and marijuana use significantly predicted increased PTSD symptoms over time and suicidal behavior. At high, but not low levels of PTSD symptoms, more days using marijuana predicted increased PTSD symptoms over time and the likelihood of suicidal behavior.

CONCLUSIONS

Results suggest marijuana, especially for military personnel experiencing elevated PTSD symptoms may negatively impact suicidal thoughts and behavior. These results are relevant to suggestions that medical marijuana could be used in treating or augmenting treatment for PTSD.

Suicidal ideation, plan, and attempts and nonmedical prescription opioid use among U.S. adults

OBJECTIVE

The increase of nonmedical prescription opioid use (NMPOU) in the United States has become a public health concern. The purpose of this study was to examine the relationship between nonmedical prescription opioid misuse and past-year suicidality (suicide ideation-SI, suicide plan-SP, and suicide attempts-SA) among U.S. adults.

METHOD

Secondary data analysis was conducted using the 2016 National Survey on Drug Use and Health with 42,625 respondents. NMPOU was grouped in 4 categories: (1) never used, (2) current user, (3) recent user, and (4) past user. The outcome variables were SI, SP and SA and they were predicted in multivariable logistic regression.

RESULTS

Compared to the never-use of NMPO groups, the current, recent, and past users of NMPO showed significantly higher likelihoods of SI, SP, and SA models adjusting for sociodemographic and mental health-related factors. Presence of a major depressive episode had the significantly highest Odds Ratio of SI, SP, and SA. Suicidality among NMPO users is high, and there are multiple, sociodemographic and mental health related factors associated with this finding.

CONCLUSION

Policy and prevention efforts to improve screening and treatment should focus on the at-risk populations identified in this study.

Perceived health, medical, and psychiatric conditions in individual and dual-use of marijuana and nonprescription opioids

OBJECTIVE

Marijuana and nonprescription opioids remain the two most commonly used illicit substances in the United States. They have commonalities, yet the use of both at the same time may have a greater impact on psychological and health outcomes. Research is needed to determine whether dual-use is associated with more negative outcomes than individual substance use.

METHOD

We used the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) Wave 1 (W1; N = 43,093), Wave 2 (W2; N = 34,653), and the more recent NESARC-III (N3; N = 36,171) to compare nonuse with use of marijuana, nonprescription opioids, or both. We examined perceived health, pain interference, pain-related medical conditions, psychiatric conditions, and suicidality.

RESULTS

Individual use and dual-use were more common in N3 than in W1. W1 dual-use and nonprescription opioid-only use predicted worse outcomes for most variables prospectively and cross-sectionally, including pain interference and poorer general health. Associations between marijuana-only use and outcomes were not as strong; however, marijuana was associated with depression and suicidal ideation.

CONCLUSION

Nonprescription opioid use is concerning with dual-use predicting poorer perceived health and pain interference with work 3 years later along with strong relationships to suicidality and psychiatric conditions. Marijuana and nonprescription opioid dual-use is a possible treatment target. Substance interventions may be enhanced by addressing alternative pain care; chronic conditions; and/or psychiatric comorbidity. Differences in outcomes between substance use and nonuse were smaller recently in N3, particularly for marijuana use only. This may be due to increased access decreasing differences between those using and not using these drugs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Prevalence and correlates of nonmedical use of prescription drugs (NMUPD) among Young adults experiencing homelessness in seven cities across the United States

BACKGROUND

Nonmedical use of prescription drugs (NMUPD) is an urgent public health concern facing the United States. Young adults experiencing homelessness (YEH) are at increased risk of NMUPD; however, community estimates of NMUPD among YEH are sparse. This current study sought to understand patterns and correlates of NMUPD in a geographically heterogeneous sample of YEH recruited from seven cities across the United States.

METHODS

From June 2016 to July 2017, 1,426 YEH (aged 18-26) were recruited from seven cities (Houston, Los Angeles, Denver, Phoenix, New York City, St. Louis, San Jose). Participants provided information on substance use, mental health, trauma, and sexual-risk behaviors. Multivariable logistic regression was utilized to assess demographic, psychological, and behavioral correlates of self-reported past-month NMUPD and NMUPD types (i.e., prescription stimulant, sedative, and opioids).

RESULTS

Approximately 20% of participants reported past-month NMUPD. Almost 9% reported misusing prescription opioids, 8.7% misused prescription sedatives, and 6% misused prescription stimulants. Multivariable logistic regressions revealed unmet mental health needs were associated with sedative and stimulant misuse but not opioid misuse. Having suicidal thoughts was associated with opioid misuse but not sedative or stimulant misuse. Although no geographical differences emerged for stimulant and sedative misuse, youth from Denver, Phoenix, and San Jose were more likely to engage in opioid misuse relative to youth in Los Angeles.

CONCLUSIONS

These findings indicate that interventions designed to address NMUPD need to be multifaceted, designed to address other risk behaviors correlated with NMUPD, and target unmet mental health needs.

Opioid Use and Misuse and Suicidal Behaviors in a Nationally Representative Sample of US Adults

Prior research has shown associations between opioid misuse and suicidal behaviors, but the relationship between medical opioid use and suicidal behaviors is not known. We assessed associations of opioid use and misuse with suicidal ideation, suicide plans, and suicide attempts among adults aged 18-64 years (n = 86,186) using nationally representative cross-sectional data from the 2015 and 2016 administrations of the National Survey on Drug Use and Health. We used logistic regression to estimate associations between opioid use/misuse and suicidal behaviors and propensity score-weighted logistic regression analysis to examine the counterfactual scenario in which persons with misuse had instead not misused opioids. In propensity score-weighted analyses, compared with opioid misuse, opioid use without misuse was associated with lower odds of suicidal ideation (odds ratio (OR) = 0.57, 95% confidence interval (CI): 0.45, 0.72) and suicide plans (OR = 0.53, 95% CI: 0.35, 0.80), and no use was associated with lower odds of suicidal ideation (OR = 0.62, 95% CI: 0.49, 0.80), suicide plans (OR = 0.56, 95% CI: 0.39, 0.79), and suicide attempts (OR = 0.54, 95% CI: 0.33, 0.89). These findings suggest that opioid misuse is associated with greater odds of suicidal behaviors, but opioid use without misuse is not. Compared with persons with opioid misuse, similar persons without misuse have a reduced risk of suicidal behaviors. Clinical and public health interventions should focus on preventing misuse of opioids.

The relationship between past 12-month suicidality and reasons for prescription opioid misuse

BACKGROUND

Understanding reasons for prescription opioid misuse can help elucidate suicide prevention efforts. The goal of the current study is to assess associations of reasons for prescription opioid misuse subtypes and suicide-related variables. We also assessed whether prescription opioid misuse differentiates ideators from those who attempt suicide.

METHODS

Using data from the 2015-2017 National Survey of Drug Use and Health (N = 45,074), prescription opioid misuse subtypes were grouped as follows: (a) Pain only, (b) Other reasons, and (c) Mixed reasons (i.e., pain and at least one other reason). Logistic regressions examined associations of misuse subtypes and past 12-month suicide-related variables (ideation, planning, attempts) relative to non-misusers. Logistic regression analyses were also conducted among the subset reporting ideation to assess whether prescription opioid misuse differentiated ideators with no attempt from ideators with an attempt.

RESULTS

In adjusted models, the Pain only and the Other reasons subtypes were associated with ideation and planning, but not attempts. The Mixed reasons subtype had higher odds of suicide ideation and planning compared to those not misusing prescription opioids and the Pain only misuse subtype. The Mixed reasons subtype had higher odds of a suicide attempt only when compared to those not misusing prescription opioids. Prescription opioid misuse was also associated with suicide attempts among the subset of ideators.

CONCLUSIONS

Findings indicate that people misuse prescription opioids for various reasons, and misuse subtypes are associated with past 12-month suicidality. Addressing pain and other reasons for misuse together through use of evidence-based treatments may help mitigate suicide risk.

Prescription opioid misuse and comorbid substance use: Past 30-day prevalence, correlates and co-occurring behavioral indicators in the 2016 National Survey on Drug Use and Health

BACKGROUND AND OBJECTIVES

Prescription opioid misuse has not been well examined in the context of comorbid substance use in representative samples of substance users. Past 30-day comorbid prescription opioid misuse and recreational substance use (eg, alcohol, marijuana, cocaine, etc.) was studied in a representative sample of substance users in the United States using the 2016 National Survey on Drug Use and Health (NSDUH).

METHODS

Prevalence of prescription opioid misuse with and without comorbid substance use was estimated with the 2016 NSDUH. Generalized linear modeling was used to describe demographic correlates of opioid and comorbid substance use and explore the relation of opioid and comorbid substance use with social and behavioral health indicators.

RESULTS

The majority of past month prescription opioid misusers reported use of other substances including cigarettes, alcohol, marijuana, or hard drugs (cocaine, methamphetamine, etc.). Males and younger respondents had a significantly higher risk of reporting past month prescription opioid misuse with illicit drug or polydrug use (p's < .01). Prescription opioid and polydrug users had the greatest odds of stealing property, selling drugs, having suicidal ideations, major depressive episode, and perceived treatment need in the past year compared to all other categories of prescription opioid misuse categories.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Prescription opioid misuse is likely a part of a larger set of psychological, behavioral, and mental health problems. More attention should be given to the profiles of recreational (non-medical) substance use involving prescription opioids to curtail the current opioid crisis and prevent other similar epidemics in the future. (Am J Addict 2019;XX:1-8).

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

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 to 2016 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 was 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.

Suicidal ideation among adults with a recent sexual assault: Prescription opioid use and prior sexual assault

INTRODUCTION

Sexual assault (SA) is common, and recent sexual assault is associated with suicidal ideation and prescription opioid (PO) use. PO use is also associated with increased risk of suicidal ideation. The current study examined suicidal ideation among adults seeking medical and psychological follow-up care after a SA medical forensic examination based on PO use and prior SA.

METHODS

Adults (n = 60) who received a SA medical forensic exam at the emergency room within 120 h of a SA were invited to receive medical and psychological follow-up care, which included a questionnaire about current mental health symptoms.

RESULTS

Results from a linear regression model revealed that more acute stress symptoms were associated with higher suicidal ideation. Further, there was a significant association between PO use and suicidal ideation among those with a prior SA such that those with a prior SA and who used POs reported more severe suicidal ideation than those with a prior SA who did not use POs.

CONCLUSIONS

Routine screening at the emergency department for PO use and prior SA may help prevention efforts for suicide among adults who recently experienced SA.

Death Ambivalence and Treatment Seeking: Suicidality in Opiate Addiction

PURPOSE OF REVIEW

Rates of suicide and opiate overdose have recently skyrocketed in the United States. In light of impulsivity and impaired motivation common in people with substance use disorders, suicidality is common in addiction.

RECENT FINDINGS

Chart review surveys indicate two primary suicidal populations that are important to distinguish for clinical practice and healthcare policy. One group is heavily composed of people with SUDs, in whom chronic compulsive use fosters a numb ambivalence about death (low death intentionality). Many of these individuals with opiate use disorder (OUD) exaggerate suicidality to get prompt psychiatric care to treat the OUD. The second group is composed of those who have co-morbid psychiatric disorders and/or chronic pain who have a higher intent to die consistent with traditionally understood suicide risk factors.

SUMMARY

We contend that easier access to outpatient opiate agonist treatment would avoid unnecessary hospitalizations for death-ambivalent OUD patients, and for OUD patients in either group. First line treatment with an opioid agonist has high potential to effectively treat suicidal ideation as a secondary benefit.

Prevalence of nonmedical use of prescription-type opioids, methylphenidate, and sedative-hypnotics among university students in the south of Iran: a regression analysis

Background and aim

Nonmedical use of prescription drugs needs particular attention. The aim of this study was to determine the prevalence of prescription-type opioids, methylphenidate and sedative-hypnotics use, and related factors in university students.

Methods

In this cross-sectional study, 524 students of Hormozgan University of Medical Sciences were selected by multi-stage sampling in 2016. A self-report questionnaire had been used examining substance use, religious beliefs and parental support. The questions about substance use were prepared based on the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST). Religious beliefs were measured by Kendler's general religiosity questionnaire. Parental support was measured by the Persian version of Aneshensel and Sucoff's scale. All of the analysis was performed using Chi-square test, Fisher exact test, independent-samples t-test and binary logistic regression in SPSS 16 software. The level of significance was 0.05.

Results

The last year prevalence of prescription-type opioids, methylphenidate and sedative-hypnotics use was 16.1%, 3.3%, and 10.3%, respectively. The final model of logistic regression indicated hookah use (OR=2.5), methylphenidate use (OR=4.5), sedative-hypnotics use (OR=2.7), and were associated with students' prescription-type opioids use. The protective factor was familial support (OR=0.97) for prescription-type opioids use. Moreover, sedative-hypnotics use (OR=5.7) and illicit drug use (OR=27.6) were associated with methylphenidate use among students.

Conclusions

The results of this study showed that the prevalence of nonmedical use of prescription drugs is considerably high among students and is in need of interventions to reduce the prevalence of these drugs in universities.

Characteristics of self-inflicted drug overdose deaths in North Carolina

BACKGROUND

Drug overdose mortality is a major public health concern in the United States, with prescription opioids contributing substantially to recent increases in drug overdose deaths. Compared to unintentional drug overdose deaths, relatively little data describes intentional self-inflicted drug overdose deaths (i.e., suicide by drug overdose). The aim of this study was to examine the characteristics of self-inflicted drug overdose deaths, overall and in comparison to unintentional drug overdose deaths.

METHODS

We linked vital statistics, prescription drug monitoring program, and toxicology data for self-inflicted and unintentional drug overdose deaths among North Carolina residents in 2012.

RESULTS

Most self-inflicted (79.2%) and unintentional (75.6%) drug overdose decedents had a prescription for a controlled substance within one year of death. Toxicology results revealed that antidepressants contributed to a significantly higher percent of self-inflicted compared to unintentional drug overdose deaths (45.0% vs. 8.1%). Among deaths in which commonly prescribed opioids (oxycodone, hydrocodone) or benzodiazepines (alprazolam, clonazepam) contributed to death, a significantly higher percent of self-inflicted drug overdose decedents had a prescription for the substance within 30days of death compared to unintentional drug overdose decedents.

CONCLUSIONS

The results highlight the use of prescription opioids, benzodiazepines, and antidepressants among self-inflicted drug overdose decedents. Importantly, the results indicate that self-inflicted drug overdose decedents were more likely than unintentional drug overdose decedents to have potential contact with the health care system in the weeks preceding death, offering an opportunity for professionals to identify and intervene on risk factors or signs of distress and potential for self-harm.

Frequency of prescription opioid misuse and suicidal ideation, planning, and attempts

The goal of this study was to examine the relationship between past-year frequency of prescription opioid misuse and past-year suicidal ideation, suicide planning, and suicide attempts. Secondary data analyses were conducted using data from 41,053 participants of the 2014 National Survey of Drug Use and Health. Past-year frequency of prescription opioid misuse was grouped into 4 categories: none, less than monthly (1-11 times), monthly to weekly (12-51 times), and weekly or more (52 times or more). Binomial logistic regression analyses adjusted for demographics, overall health rating, depression, anxiety, and substance use disorders to test the associations between frequency of prescription opioid misuse and suicide-related variables. Compared to those who did not endorse prescription opioid misuse in the past year, prescription opioid misuse was significantly associated with suicidal ideation, suicide planning, and suicide attempts for each frequency of use category in unadjusted models (p < 0.05). In adjusted models, frequency of prescription opioid misuse remained significantly associated with suicidal ideation (p < 0.05 for each frequency category); however, only the group reporting weekly or more use on average was associated with suicide planning and attempts (p < 0.05). The findings provide novel specificity regarding prescription opioid use in relation to suicide-related outcomes further supporting enhanced access to suicide prevention and nonpharmacological approaches to pain management across various settings.

The Role of Gender in Suicidal Ideation among Long-term Opioid Users

OBJECTIVE

This study aims to examine factors associated with suicidal ideation among people with opioid dependence and to explore whether these factors are gender-specific.

METHODS

Cross-sectional data were collected among long-term opioid-dependent individuals ( n = 176; 46.0% women). Lifetime histories of suicidal ideation were measured using the Composite International Diagnostic Interview, and additional data were collected regarding sociodemographic characteristics, drug use, health, and adverse life events. Multivariable logistic regression was used to determine the relationships between these variables and suicidal ideation for the full study sample and separately for women and men to explore the potential role of gender.

RESULTS

A total of 43.8% ( n = 77) of participants reported a lifetime history of suicidal ideation. Among those with suicidal ideation, 49.3% were women and the overall average age of first ideation was 19.82 years (SD, 11.66 years). Results from multivariable analyses showed that a history of depression, anxiety, and childhood emotional neglect and the number of lifetime traumatic events were significantly associated with higher odds of suicidal ideation. The gender-based analysis suggested that histories of depression and anxiety remained independently associated with lifetime suicidal ideation among women, whereas for men, childhood emotional neglect and the number of lifetime potentially traumatic events were independently associated with lifetime suicidal ideation.

CONCLUSIONS

This study offers a critical first step to understanding factors associated with suicidal ideation among long-term opioid-dependent men and women and the potential importance of gender-sensitive approaches for suicidal behavior interventions. These data inform further research and clinical opportunities aiming to better respond to the psychological health needs of this population.

Gender differences among medically serious suicide attempters aged 15-54 years in rural China

China is one of few countries which reported higher female suicide rates in the worldwide. However, little is known about the gender differences among Chinese rural suicide attempters. This study aims to analyze the gender differences among medically serious suicide attempters aged 15-54 years in rural China. Subjects were 791 medically serious suicide attempters and 791 controls aged 15-54 years in rural China. Socio-demographic, psychological and some critical variables were assessed in the interview. The results showed that all of the factors (education years, family suicide history, negative life events, social support, impulsivity and mental disorder) associated with male suicide attempters also could be found for females. Physical disease, mental disorder and pesticide ingestion played more roles on male suicide attempters. Ever married, peasant, religious belief, and less social support played more roles on female suicide attempters. Compared with male suicide attempters, female ones are mainly influenced by social factors. A gender-specific approach should be emphasized in suicide prevention.

Longitudinal trajectories of non-medical use of prescription medication among middle and high school students

The non-medical use of prescription medications has been identified as a major public health problem among youth, although few longitudinal studies have examined non-medical use of prescription medications in the context of other drug use. Previous cross-sectional studies have shown gender and race differences in non-medical use of prescription medications. It was hypothesized that (1) non-medical use of prescription medications increases with age, and (2) these increases will be stronger in magnitude among female and Caucasian adolescents. Changes in non-medical use of prescription medications across 4 years were examined and compared with changes in other drug use (e.g., alcohol and marijuana). Middle and high school students enrolled in 5 schools in southeastern Michigan completed web-based surveys at 4 annual time points. The cumulative sample size was 5,217. The sample ranged from 12 to 18 years, 61% were Caucasian, 34% were African American, and 50% were female. Using a series of repeated measures latent class analyses, the trajectories of non-medical use of prescription medications were examined, demonstrating a 2-class solution: (1) the no/low non-medical use of prescription medications group had low probabilities of any non-medical use of prescription medications across all grades, and (2) the any non-medical use of prescription medications group showed a roughly linear increase in the probability of non-medical use of prescription medications over time. The probability of any non-medical use of prescription medications increased during the transition from middle school to high school. Results from this longitudinal study yielded several noteworthy findings: Participants who were classified in the any/high non-medical use of prescription medications group showed a discontinuous pattern of non-medical use of prescription medications over time, indicating that non-medical use of prescription medications is a relatively sporadic behavior that does not persist over time. However, among the "any/high non-medical use of prescription medications" group the pattern of change over time varied by race/ethnicity, with Caucasians showing a clear increase in the probability of non-medical use of prescription medications over time compared to non-Caucasians. This study fills gaps in knowledge by examining non-medical use of prescription medications over time and provides important information about the course of non-medical use of prescription medications among adolescents.

The association between nonmedical use of prescription medication status and change in health-related quality of life: results from a Nationally Representative Survey

BACKGROUND

Nonmedical use of prescription medication (NUPM) is associated cross-sectionally with a host of medical and psychosocial consequences. Few studies, however, have examined longitudinal outcomes based on NUPM indicators. This study aimed to address this gap by examining change in health-related quality of life as a function of NUPM status.

METHODS

Data are from waves 1 and 2 of the National Epidemiological Survey on Alcoholism and Related Conditions (NESARC) a household-based, nationally-representative survey of the US population. 34,653 participants who completed both NESARC waves were included in analyses. The primary outcome measure was the 12-item Short Form Health Survey (SF-12), with history of NUPM of opioids, tranquilizer/sedatives and stimulants (examined separately) at wave 1 and any NUPM between waves 1 and 2 used to group participants. Sociodemographic characteristics were used as control variables.

RESULTS

Across medication classes, results indicated that individuals who initiated NUPM between waves (initiators) had greater declines or smaller increases on many SF-12 scales, when compared to other groups. Individuals with a history of NUPM at wave 1 but no use between waves (quitters) and never users generally had the best outcomes in terms of change in SF-12 scales, with quitters making larger gains (or smaller losses) in mental health-related quality of life. Persistent users were generally intermediate between initiators and quitters or never users.

CONCLUSIONS

These data reinforce the importance of preventing NUPM initiation and of promoting NUPM cessation, highlighting the need for greater use of NUPM-related public health interventions.

Seasonal variation in suicidal behavior with prescription opioid medication

BACKGROUND

Suicide attempts by self-poisoning utilizing prescription opioids account for more than half of prescription drug abuse and misuse emergency calls received by poison centers. Additionally seasonal suicidal behavior using other means is a commonly replicated finding. We hypothesized seasonal behavior would exist in individuals using opioid medication as a suicide means, and that this pattern would change at different latitudes in the United States.

METHODS

We used a harmonic regression strategy to investigate sinusoidal seasonal variations of suicidal behavior utilizing prescription opioids, and to contrast changes in seasonal behavior by latitude within the United States. Further, we investigated associations between suicide frequency utilizing opioid medication and frequency of dispensed opioid prescriptions.

RESULTS

Seasonal patterns were identified; overall, all harmonic terms were significant (p<0.05). Interaction terms of harmonic by latitude and harmonic by gender also were significant (p<0.05). After stratification, females had significant harmonic terms at all latitudes. A changing peak time period with latitude also was observed, such that the peak appeared later at more southern latitudes. Additionally, increased dispensed prescriptions rates per population were associated with increased suicidal behavior utilizing prescription opioids.

LIMITATIONS

This study has limitations due to its ecological nature and to missing data that may inform our understanding of suicide risk factors, such as marital status and socio-economic status.

CONCLUSION

Suicidal behavior with prescription opioids follows a seasonal pattern that changes with latitude within the United States. Further, increased accessibility may contribute to increased suicidal attempt rates utilizing prescription opioids.