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Lovejoy TI, Demidenko MI, Morasco BJ, Meath T, Dobscha SK. Suicidal ideation and behaviors following clinician-initiated prescription opioid discontinuation among long-term opioid users. [Abstract]. The journal of pain : official journal of the American Pain Society. 2017 Apr 1; 18(4):S36.
Rates of clinician-initiated discontinuation of long-term opioid therapy (LTOT) for chronic pain are increasing, particularly for patients who may be considered 'complex' given significant medical, mental health, and substance use disorder comorbidities. Although it is unclear if opioid therapy discontinuation leads to exacerbation of pain, higher pain intensity is associated with suicidal ideation and self-directed violent behaviors. The objectives of this study were to (1) estimate the prevalence of suicidal ideation (SI) and suicidal self-directed violence (SSV) and (2) identify predictors of SI/SSV following clinician-initiated discontinuation of LTOT. This retrospective study utilized VA electronic medical record data to assemble a cohort of all VA patients prescribed continuous opioid therapy in 2011 who subsequently discontinued opioid therapy in 2012. A random sample of 600 patients was selected and medical charts reviewed to ascertain reasons for LTOT discontinuation and the presence of SI or SSV in the year following discontinuation of LTOT. Logistic regression examined correlates of SI/SSV post-discontinuation among the 509 patients whose clinicians initiated LTOT discontinuation rather than discontinuation that was initiated by patients. Twelve percent of patients (n = 59) had SI and/or SSV documented in the medical record in the year following discontinuation of LTOT. Forty-seven had SI only, while 12 had SSV. In unadjusted models, patients with SI/SSV following discontinuation of LTOT were more likely to have diagnoses of PTSD (OR = 1.94[1.12-3.37]), psychotic disorder (OR = 2.35[1.06-5.21]), and sedative use disorder (including abuse of benzodiazepines; OR = 3.56[1.06-11.96]), and have been discontinued by clinicians due to concerns about patient safety (OR = 2.28[1.00-5.25]). Covariate-adjusted models that controlled for demographic characteristics, medical comorbidity, and treatment utilization were consistent with unadjusted models. Results point to the importance of monitoring mental health symptoms, particularly suicidal ideation and behaviors, following discontinuation of LTOT