Behavioral Therapy Could Reduce Suicidal Behavior for Patients with Opioid Use Disorder

Mir M. Ali

The link between opioid use disorder (OUD) and high rates of co-occurring mental health conditions is well-known. However, there is less of an understanding of how suicidal behaviors might be impacted by this condition.

A team, led by Mir M. Ali, Office of the Assistant Secretary for Planning & Evaluation, US Department of Health & Human Services, examined suicidal behavior, defined as suicidal ideations and/or attempts, and the utilization of behavioral health services for patients with OUD.

The Data

In the study, the researchers used the 2015-2018 National Survey of Drug Use and Health to identify the risk of suicidal behavior among individuals with opioid use disorder and examined how the utilization of behavioral health treatment among this patient population might ultimately reduce the risk of suicidal behavior.

The overall rate of suicidal behavior was 22% in individuals with OUD, significantly higher than the 4% found in a cohort of patients without OUD.

In addition, 43% of patients with OUD received neither substance use disorder nor mental health treatment.

The Value of Treatment

After using a multivariable logistic regression, the researchers estimated indicate that individuals with OUD had odds of suicidal behavior 2.9 times as high as those without OUD.

The odds of suicidal behavior of the OUD cohort was 49% lower with substance use disorder treatment, as well as 5% reduced with mental health treatment and 28% lower with both mental health and substance use disorder treatment.

“Individuals with OUD have a high risk of suicidal behavior, which can be mitigated with utilization of behavioral health treatment,” the authors wrote. “These findings underscore the importance of policy initiatives directed at increasing treatment utilization among those with OUD.”

Opioid Use Disorder During COVID-19

Recently, researchers found the rates of new patients receiving treatment for OUD decreased significantly through the beginning of the pandemic.

Investigators, led by Janet M. Currie, PhD, of the Center for Health and Wellbeing at Princeton University, evaluated how the prescription of medications for OUD changed for new and current patients during COVID-19.

The 2 medications generally prescribed included opioid analgesics for pain management and buprenorphine for OUD. Investigators found a decrease in opioid analgesic prescriptions and an increase in buprenorphine prescriptions for OUD before the COVID-19 pandemic.

The team’s exact numbers included 452,691,261 opioid analgesic prescriptions and 90,420,353 buprenorphine prescriptions.

From March to May, there were 1877 million units of milligrams of morphine equivalents (MME) opioid analgesics prescribed weekly, versus the 1843 million that were projected.

Opioid-naïve patients received 370,051 prescriptions, versus the 564,929 projected. 

Existing OUD patients for buprenorphine experienced similar numbers to those projected by investigators. Despite initial decreases in prescriptions, each prescription was for a larger quantity, causing little change in MME supply rates.

New patients of buprenorphine experienced 9865 prescriptions versus the 12,008 projected, or 18% lower than the expected levels.

From May to September, the prescription of opioids returned to 100%, with levels reaching 90% of projected numbers for new patients by August.

Existing patients did not experience a disruption in their supply during the COVID-19 pandemic, but opioid-naïve patients were less likely to be prescribed.

The study, “Suicidal Behavior, Opioid Use Disorder, and Behavioral Health Treatment: Prevalence and Correlates among Adults in the United States 2015–2018,” was published online in the Journal of Substance Abuse Treatment.