Cessation of Medications for Opioid Use Disorder Associated With an Increased Risk for Self-harm and Suicide

People with opioid use disorder (OUD) are at high risk for suicide and self-harm; prior studies have found that medications for opioid use disorder (MOUD) decrease this risk. Researchers investigated the rates of self-harm and suicide during different MOUD exposure periods, using data from the Opioid Agonist Treatment Safety retrospective cohort study conducted in Australia. Included were 45,664 individuals initiating or receiving long-term treatment with methadone or buprenorphine from 2002 to 2017. MOUD exposure was divided into 4 distinct time periods: 1–28 days receiving MOUD, ≥29 days receiving MOUD, 1–28 days after MOUD cessation, and ≥29 days after MOUD cessation.

• Opioid-related overdose was reported in 28 percent of self-harm-related hospitalizations, and 10 percent of suicides in this population.
• Compared with the time period ≥29 days receiving MOUD:
  • the risk of self-harm hospitalization was greatest 1–28 days after MOUD cessation (adjusted risk ratio [aRR], 2.7) and in the first 1–28 days of receiving MOUD (aRR, 2.2).
  • the risk for suicide was substantially elevated 1–28 days after MOUD cessation (aRR, 17.4), and less so for the remainder after MOUD cessation (aRR, 1.4).

Comments: This study confirms prior observations of a protective effect of MOUD on self-harm and suicide. It also shows that the initial period following MOUD cessation is a high-risk time, similar to the increased risk of unintentional overdose. This reinforces the importance of initiating and continuing MOUD among individuals with OUD.

Darius A. Rastegar, MD

Reference: Colledge-Frisby S, Jones N, Degenhardt L, et al. Incidence of suicide and self-harm among people with opioid use disorder and the impact of opioid agonist therapy: a retrospective data linkage study. Drug Alcohol Depend. 2023;246:109851.