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Am J Epidemiol. 2019 Mar 5. pii: kwz061. doi: 10.1093/aje/kwz061. [Epub ahead of print]

Opioid Use, Misuse, and Suicidal Behaviors in a Nationally Representative Sample of U.S. Adults.

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Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of Psychiatry, Columbia University Medical Center, New York, NY.


Prior research has shown associations between opioid misuse and suicidal behaviors, but the relationship between medical opioid use and suicidal behaviors is not known. We assessed associations between opioid use and misuse to suicidal ideation, suicide plans, and suicide attempts among adults 18-64 years old (n=86,186) using nationally representative cross-sectional data from the 2015-2016 National Survey on Drug Use and Health. We used logistic regression to estimate associations between opioid use/misuse and suicidal behaviors and propensity score weighted logistic regression to examine the counterfactual scenario in which individuals with misuse had instead not misused opioids. In propensity score weighted analyses compared to opioid misuse, use without misuse was associated with lower odds of ideation (odds ratio [OR]=0.57; 95% confidence interval [CI]: 0.45, 0.72) and plans (OR=0.53; 95% CI: 0.35, 0.80), and no use was associated with lower odds of ideation (OR=0.62; 95% CI: 0.49, 0.80), plans (OR=0.56; 95% CI: 0.39, 0.79), and attempts (OR=0.54; 95% CI: 0.33, 0.89). Opioid misuse is associated with greater odds of suicidal behaviors but use without misuse is not. Compared to individuals with opioid misuse, similar individuals without misuse have reduced risk of suicidal behaviors. Clinical and public health interventions should focus on preventing misuse.


attempted suicide; non-medical use of prescription drugs; opioid abuse; opioids; prescription drug misuse; suicidal ideation; suicide


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