Impact of Opioid Prescriptions on Suicide Risk Among Veterans With Musculoskeletal Disorder (MSD) Diagnoses

Starosta AJ, Hastings J, Nazem S, Ronzitti S, Goulet JL. Impact of Opioid Prescriptions on Suicide Risk Among Veterans With Musculoskeletal Disorder (MSD) Diagnoses. [Abstract]. Archives of physical medicine and rehabilitation. 2018 Oct 1; 99(10):e63.

Research Objectives To examine associations between dispensed opioid prescriptions and suicide among veterans with MSD diagnoses in Department of Veterans Affairs (VA) care. Design Retrospective validation cohort study using VA clinical and administrative databases. Setting National VA Health Administration facilities. Participants The sample comprised 2,027,591 Veterans with one or more MSD, at least one ambulatory care visit in the year prior to the MSD diagnosis date, no opioid prescriptions dispensed in that year, at least one year survival after diagnosis (to calculate opioid exposure), and up to 5 years of follow-up from the MSD date. Interventions Not Applicable. Main Outcome Measure(s) Suicide death recorded in National Death Index data. Results During the observation period, 4,578 Veterans died by suicide. In bivariate analyses, Veterans who died by suicide were significantly more likely to have had: an opioid prescription dispensed, a longer duration of opioids, and higher average doses. In multivariate models adjusted for demographic and clinical factors, including prior suicide attempts, duration of opioid and higher dose were significantly associated with higher rates of suicide. In both cases, risk was significantly higher for white Veterans and male Veterans, and for those reporting severe pain on the MSD diagnosis date. Conclusions Prescription opioid use is associated with higher risk of suicide death among Veterans with MSD diagnoses. While Although additional research is needed to identify the underlying mechanisms contributing to increased suicide mortality, results highlight the critical need for providers to consider the potential of opioid prescriptions to increase suicide risk. Additionally, results support ongoing efforts to minimize the role of opioids in the treatment of chronic pain and highlight the continued need for alternative pain management strategies. Author(s) Disclosures None. Key Words Opioids, Suicide, Veterans, Pain