Suicide is the 10th leading cause of death in the United States, and in 2017 alone, there were 70,237 drug overdose deaths, including 67.8 percent from prescription opioids prescribed for pain. In 2017, the suicide rate for Veterans was 1.5 times the rate for non-Veteran adults. The rate of opioid use disorder is seven times higher among Veterans in VHA care than patients in other healthcare systems. This retrospective study compared overdose and suicide incidence across facility, regional and national levels in VHA systems in the context of a multispecialty opioid risk reduction program that included alternative, non-opioid pain therapies. Did a new approach have a positive impact on these at-risk patients?
“There are anecdotal reports that decreasing or stopping opioid pain medications might lead to increased veteran suicides,” says Charles E. Levy, MD, Chief of Physical Medicine and Rehabilitation Service at North Florida/South Georgia Veterans Health System (NF/SGVHS), and the study’s presenting author. This health system has aggressively tapered and stopped opioids through a multidisciplinary clinic equipped to offer improved non-opioid pain care options and treat opioid addiction. “This study suggests that if opioids are tapered or stopped with proper patient support, suicide outcomes can be extremely low. In fact, for the time studied, this system’s suicide rates were 36 percent less than civilian suicide rate, and 75 percent less than the national veteran suicide rate.”
The researchers examined aggregated drug overdose and annual suicide rate data from Fiscal Year 2012 to Fiscal Year 2016 from the VA Support Service Center Medical Diagnosis Cube and VA Suicide Prevention Program databases, and evaluated data at the facility, regional and national levels. They aggregated overdose data by facility and fiscal year, and calculated overdose rates per 1,000 for unique veterans.
Dr. Levy and his research team found that the average annual rate of overdose diagnosis for the facility during the study period was slightly higher compared to regional and VHA national rates, but had less variability compared to regional and national rates. The facility had the lowest average annual rate of suicide, or 9.1 out of 100,000, during the study period, less than one quarter of the national rate.
The study’s findings suggest that the presence of a multispecialty opioid risk reduction program with addiction management treatment approaches may explain the reduced suicide rates even during a period when the facility was tapering opioid prescriptions.
“Opioids appear to be a risk factor for suicide. Stopping or tapering opioids can be done safely if done with an approach where the patient is supported by frequent follow up, offering improved non-opioid pain care options and treating addiction. Our study supports the practice of tapering or stopping opioids within the context of a multidisciplinary approach that supports the patient,” says Dr. Levy.
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