Fewer opioid prescriptions are associated with declines in total suicide deaths, a study shows, but inverse relationships were observed in younger age groups.
Using the 2009–2017 U.S. national IQVIA Longitudinal Prescription Database data and National Center for Health Statistics mortality data aggregated into commuting zones (N = 886), the retrospective study assessed opioid prescription exposures as reflected in opioid prescriptions per capita and percentages of patients with any opioid prescription, with high-dose prescriptions (>120 mg of morphine equivalents), with long-term prescriptions (≥60 consecutive days), and with prescriptions from 3 or more prescribers. “Suicide deaths were significantly positively associated with opioid prescriptions per capita (β = 0.045), having any opioid prescription (β = 0.069), having high-dose prescriptions (β = 0.024), having long-term prescriptions (β = 0.028), and having three or more opioid prescribers (β = 0.046),” the authors report. “Similar significant associations were observed between each of the five opioid prescription measures and suicide overdose deaths involving opioids (β range, 0.029–0.042). However, opioid prescriptions per capita, having any opioid prescription, and having three or more opioid prescribers were each negatively associated with unintentional opioid-related deaths in people in the 10- to 24-year and 25- to 44-year age groups.”
Editorial: “Perhaps declines in opioid prescribing are not evenly distributed across all patients and may have disproportionately untoward impacts on certain groups, such as diminishing access to pain management interventional strategies, precipitating mental health crises, and promoting use of illicit opioids with higher potential for lethality,” editorialists write. “Given the robust and otherwise consistent findings of [this] study, further exploration of the lone outlier—young and middle-aged adults’ rates of unintentional opioid overdose—seems a logical next step to inform efforts to mitigate any potential untoward impact of conservative prescribing efforts on this population.
“Finally, efforts to curb opioid prescribing continue across the country. However, the landscapes of youth suicide and opioid-related overdose have shifted notably over the past 3 years. Replication of the present study as more recent data reflective of trends emerging during the COVID-19 pandemic become available would be helpful in benchmarking the impact of current community-level efforts to reduce opioid prescribing.”