People on long-term opioid treatment can be reassured that stopping these medicines is not likely to increase their risk of suicide or fatal overdose, thanks to a major new study from the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney.
The Australian-first research, based on data from 3.57 million people prescribed opioids, found no evidence of an association between opioid discontinuation and death from suicide or overdose.
With growing concerns about the limited benefits and potential risks of long-term opioid use, there is increasing interest in understanding what happens when these medicines are tapered or stopped.
The new findings are particularly important, as previous studies from the US and Canada have suggested that stopping opioid treatment may increase the risk of fatal outcomes, including suicide and overdose.
"Our study provides timely and reassuring evidence for clinicians and individuals considering stopping long-term opioid treatment," said lead researcher, Scientia Associate Professor Natasa Gisev.
"Not only did we find no increased risk of suicide, but individuals were also half as likely to experience a fatal unintentional overdose.
"These findings represent a critical contribution to the evidence base on opioid deprescribing given the global focus on reducing opioid-related harms and rates of use without compromising patient safety or quality of life."
As part of the study, published in PAIN, the researchers identified more than 371,000 adults in NSW who had used opioids continuously for at least six months between 2003 and 2018.
This included 523 people who had died by suicide and 671 people who died from an unintentional overdose, most of whom were men.
Compared to ongoing use, opioid discontinuation was not associated with an increased risk of suicide. This remained the case even after accounting for risk factors such as mental health conditions and substance use disorders.
The authors also found that discontinuing opioids led to a 55% lower risk of fatal unintentional overdose, with the magnitude of this effect being more pronounced over time.
"Given the high prevalence of chronic pain in the community and the continued rates of opioid prescribing– despite recent declines – this work offers valuables insights for healthcare professionals and individuals living with chronic pain," A/Prof Gisev said.
"However, we also need further research into the non-fatal outcomes of opioid discontinuation among people with chronic pain, such as the impact on pain management, and physical and emotional wellbeing.
"Such evidence may inform the implementation of safe and effective strategies for discontinuing opioids where clinically appropriate."
