Frequency and recency of non-medical opioid use and death due to overdose or suicide among individuals assessed for risky substance use: A national registry study in Sweden

Lena Lundgren,Mojgan Padyab,Mikael Sandlund,Dennis Mccarty

doi:10.1016/j.jsat.2021.108567

Lena Lundgren, Mojgan Padyab + Show 2 more

Open Access

https://doi.org/10.1016/j.jsat.2021.108567

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Abstract

Sweden and many other countries have experienced increases in suicide and accidental overdose deaths. An analysis examined the associations between recency of non-medical opioid misuse and frequency of use of non-medical opioids with death due to either suicide or accidental overdose within a sample of 15,000 Swedish adults who completed an Addiction Severity Index (ASI) assessment for risky substance use or a substance use disorder. Methods and materialsSuicide (n = 136) and death due to overdose (n = 405) were identified in the official Cause of Death Registry from the Swedish National Board of Health and Welfare. Control variables included demographic characteristics and risks associated with either overdose or suicide. Cox regression analyses controlled for variables statistically significantly at the bivariate level. ResultsAt the multivariable level: a) a higher (modified) ASI Composite Score for mental health; b) history of suicide attempt; c) having used non-medical opioids for 1–2 times per week for at least a year; d) history of injection drug use; and, e) early onset of drug use, were all significantly and positively associated with death due to suicide. At the multivariable level: a) a higher the revised ASI Composite Score for mental health; b) recency of use of non-medical opioids; c) frequency of non-medical opioid use; d) being a male; and e) being of ages 18–24 years compared to ages 43–51 years were all positively and significantly associated with death due to accidental overdose. ConclusionThese findings underscore the need to integrate mental health and substance use disorder treatment and provide suicide and overdose prevention interventions for individuals with an opioid use disorder. Recency and frequency of non-medical opioids were only associated with death due to overdose and not suicide. However, other drug use related variables (using opioids 1–2 times per week for at least a year, early onset of drug use and drug injection) were significantly associated with death due to suicide.

Highlights

Sweden and many other countries have experienced increases in suicide and accidental overdose deaths
A longitudinal cohort analysis examined the associations of fre quency and recency of opioid use and deaths due to either suicide or overdose over a 14-year period in Sweden among people assessed for a substance use disorder
Consistent with studies examining the relationship of opioid misuse with non-fatal sui cidal ideation planning and attempts (Kuramoto et al, 2012, Ashrafioun et al, 2017), recency and frequency of non-medical opioid use were both strongly associated with suicide and overdose

Summary

Introduction

Sweden and many other countries have experienced increases in suicide and accidental overdose deaths. Results: At the multivariable level: a) a higher (modified) ASI Composite Score for mental health; b) history of suicide attempt; c) having used non-medical opioids for 1–2 times per week for at least a year; d) history of injection drug use; and, e) early onset of drug use, were all significantly and positively associated with death due to suicide. At the multivariable level: a) a higher the revised ASI Composite Score for mental health; b) recency of use of non-medical opioids; c) frequency of non-medical opioid use; d) being a male; and e) being of ages 18–24 years compared to ages 43–51 years were all positively and significantly associated with death due to accidental overdose. Suicidal ideation and suicidal attempt are strongly asso ciated both with fatal and nonfatal overdose and suicide (Vingoe, Welch, Farrell, & Strang, 1999; Rossow & Lauritzen, 1999; Hakansson et al, 2008; Maloney et al, 2007; Pan et al, 2014)

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