Treating opioid use disorder significantly lowers the very high rate (8 times the general population) of suicide among people with opioid dependence.
A Scottish study, led by Glasgow Caledonian University, supported by the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol reports of over 45,000 patients receiving methadone or buprenorphine for opioid use disorder reported this important result in the scientific journal Addiction.
There were 575 suicides among the group of 46,453 people with opioid use disorder, accounting for 1.2% of the group. Although every member of the group received an OAT prescription at some point between 2011 and 2020, some of those suicides occurred during periods when people were not in receipt of an OAT prescription. The study assumed that every suicide that occurred more than 60 days after the person received an OAT prescription would have happened while the person was not on drug treatment for opioid dependence.
When researchers divided the 575 suicide deaths into those occurring while the person was on OAT versus those committed while the person was no longer on OAT, they found that the rate of suicide for people not on OAT was more than three times higher than the rate for people on OAT.
Lead author and researcher at Glasgow Caledonian University Rosalyn Fraser commented:
People with opioid dependence in Scotland are at much higher risk of suicide than the general population. But there is strong evidence that suicide rates are lower among people receiving methadone or buprenorphine. OAT helps people access other support services, stabilises drug use, and provides opportunities to build therapeutic relationships and reduce isolation. It’s very important to get people with opioid dependence into drug treatment to reduce their suicide risk.
Senior author and Glasgow Caledonian University Professor in Public Health Andrew McAuley added:
In Scotland, trends in suicide in people who are opioid dependent declined during a period where overdose deaths more than doubled. Importantly, retention in opioid agonist treatment is a critical intervention both for suicide and opioid overdose prevention strategies.
Matthew Hickman, Professor in Public Health and Epidemiology in Bristol Medical School: Population Health Sciences (PHS) and Head of Bristol’s HPRU, said:
We do think the reduction in suicide when people are on Opioid Agonist Treatment (OAT) is due to combination of pharmacotherapy and psychological interventions delivered during OAT. However, we did not have detailed exposure information on the intensity or duration of psychological interventions. We note also that suicide rate in people who are dependent on opioids in Scotland is substantially higher than risk in the general population and higher than equivalent populations elsewhere – such as people in OAT in New South Wales. Therefore, the implication is whether additional self-harm and suicide prevention interventions should be added to psychological interventions delivered during OAT and whether it is possible to target these to people with opioid dependence who are greater risk of suicide.
