Opioids linked to elevated risk for suicidal behavior in Swedish study

Young people who were prescribed opioids had a 19% relatively greater risk for suicidal behavior than those who took prescription NSAIDs, according to a study of Swedish data that was published in Pediatrics.

“Suicide is the second leading cause of death among those aged 10 to 34 years,” the researchers wrote. “Suicide by opioid overdose in particular is increasing. Its contribution to U.S. suicide mortality doubled from 1999 to 2014, adding to broader concerns regarding adverse effects of prescription opioids.

“Pain and its management with opioids are common among young people. There is, therefore, a clear need to understand the potential contribution of opioid prescription to risk of suicidal behavior in young people.”

The authors analyzed Swedish population register data on nearly 1.9 million people aged 9 to 29 years without prior recorded opioid prescriptions. They identified prescriptions dispensed from January 2007 onward and diagnosed self-injurious behavior and death by suicide through December 2013. Ultimately, 201,433 members of the cohort initiated opioid prescriptions.

They found that opioid initiators had more than double the risk for incident suicidal behavior (HR = 2.64; 95% CI, 2.47-2.81), although in the active comparator design — “which examined suicidal behavior among opioid initiators relative to NSAID initiators while inverse-probability-of-treatment weighting with individual and familial covariates” — opioid initiators had a 19% relatively greater risk for suicidal behavior compared with NSAID initiators (HR = 1.19; 95% CI, 1.11-1.28). That corresponded to a weighted 5-year cumulative incidence of 2.2% (95% CI, 2.1-2.4) for opioid and 1.9% (95% CI, 1.9-2.0) for NSAID initiators.

“Opioid initiation may make only a small contribution to the elevated risk of suicidal behavior among young people receiving pharmacologic pain management,” they wrote. “In weighing benefits and harms of opioid initiation, our results suggest that increased risk of suicidal behavior may not be a major concern.”