Initiation of Opioid Prescription and Risk of Suicidal Behavior Among Youth and Young Adults.

Autor:	Fine KL; Department of Applied Health Science, School of Public Health., Rickert ME; Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana., O'Reilly LM; Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana., Sujan AC; Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana., Boersma K; Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work., Chang Z; Departments of Medical Epidemiology and Biostatistics., Franck J; Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden., Lichtenstein P; Departments of Medical Epidemiology and Biostatistics., Larsson H; School of Medical Sciences, Örebro University, Örebro, Sweden.; Departments of Medical Epidemiology and Biostatistics., D'Onofrio BM; Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana.; Departments of Medical Epidemiology and Biostatistics., Quinn PD; Department of Applied Health Science, School of Public Health.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2022 Mar 01; Vol. 149 (3).
DOI:	10.1542/peds.2020-049750
Abstrakt:	Background and Objectives: Opioids are involved in an increasing proportion of suicide deaths. This study examined the association between opioid analgesic prescription initiation and suicidal behavior among young people. Methods: We analyzed Swedish population-register data on 1 895 984 individuals ages 9 to 29 years without prior recorded opioid prescriptions. We identified prescriptions dispensed from January 2007 onward and diagnosed self-injurious behavior and death by suicide through December 2013. We first compared initiators with demographically matched noninitiators. To account for confounding, we applied an active comparator design, which examined suicidal behavior among opioid initiators relative to prescription nonsteroidal antiinflammatory drug (NSAID) initiators while inverse-probability-of-treatment weighting with individual and familial covariates. Results: Among the cohort, 201 433 individuals initiated opioid prescription. Relative to demographically matched noninitiators, initiators (N = 180 808) had more than doubled risk of incident suicidal behavior (hazard ratio = 2.64; 95% confidence interval [CI], 2.47-2.81). However, in the active comparator design, opioid initiators (N = 86 635) had only 19% relatively greater risk of suicidal behavior compared with NSAID initiators (N = 255 096; hazard ratio = 1.19; 95% CI,: 1.11-1.28), corresponding 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. Most sensitivity analyses produced comparable results. Conclusions: Opioid initiation may make only a small contribution to the elevated risk of suicidal behavior among young people receiving pharmacologic pain management. In weighing benefits and harms of opioid initiation, our results suggest that increased risk of suicidal behavior may not be a major concern. Competing Interests: POTENTIAL CONFLICT OF INTEREST: Dr Larsson has served as a speaker for Evolan and Shire and has received research grants from Shire, all outside the submitted work. The authors report no other conflicts of interest. (Copyright © 2022 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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