New research challenges fears about stopping long-term prescription opioid use, uncovering no associated rise in suicide risk and a sharp drop in overdose death. The findings offer reassurance for clinicians and patients managing chronic pain.
Previous studies and current professional guidelines have suggested that abruptly discontinuing prescription opioid treatment might trigger harm – especially suicide or overdose – among people who had been taking these drugs over the long term for chronic pain.
Now, a new study led by the National Drug and Alcohol Research Center (NDARC), which is attached to the University of New South Wales (UNSW), has put that concern to rest.
“Our study provides timely and reassuring evidence for clinicians and individuals considering stopping long-term opioid treatment,” said the study’s senior author, Natasa Gisev, a clinical pharmacist and Scientia Associate Professor at NDARC. “Not only did we find no increased risk of suicide, but individuals were also half as likely to experience a fatal unintentional overdose.”
The researchers examined prescription and health records from more than 371,000 adults in NSW, Australia, who’d been on opioids for at least six months between 2003 and 2018. They identified two groups of people who died by suicide or from an accidental overdose. Each person who died (a “case”) was compared with 10 similar people (called “controls”) who were the same age and sex but were still alive at that time. Then they checked whether these people had stopped or continued their opioid prescriptions, based on pharmacy records. Their analysis adjusted for many other factors that could affect risk, like mental illness, substance use disorders, and the use of psychiatric medications.
A total of 523 people, mostly men, died by suicide. After adjusting for all other factors, stopping opioids was not linked to a higher risk of suicide. Statistically, those who stopped taking opioids were about as likely to die by suicide as those who continued taking them. There were 671 deaths caused by unintentional overdose: again, mostly men. In this case, stopping opioids was actually linked to a lower risk (55%) of dying from an overdose compared to staying on them. The longer someone had been off opioids, especially if it was for more than 90 days, the lower their risk of overdose.
“Given the high prevalence of chronic pain in the community and the continued rates of opioid prescribing – despite recent declines – this work offers valuable insights for healthcare professionals and individuals living with chronic pain,” Gisev said. “However, we also need further research into the non-fatal outcomes of opioid discontinuation among people with chronic pain, such as the impact on pain management and physical and emotional well-being.
“Such evidence may inform the implementation of safe and effective strategies for discontinuing opioids where clinically appropriate.”
The study was published in the journal PAIN.
Source: UNSW
