Suicidal thoughts are common in patients starting buprenorphine for opioid use disorder in an office setting, a new study found. The risk is highest in people who were physically abused or who live with chronic pain, anxiety or depression. So doctors need to ask about suicidal thoughts when buprenorphine starts.
Summary: Buprenorphine is a top choice for treating opioid use disorder (OUD) outside the hospital. But doctors need to know that many of these patients think about suicide. Studies show the risk is higher in people who were physically abused. It is also higher in people who live with chronic pain, anxiety or depression.
Luckily, opioid use disorder (OUD) rates have started to fall in the US, thanks to more careful use of opioids by doctors. Still, OUD will be a big problem for years to come.
Many people with OUD also live with mood disorders and with short-term and long-term pain. In fact, many started using opioids to cope with chronic pain and mental distress, and later became addicted. So these factors must be kept in mind when treating OUD patients.
Buprenorphine is one of the most used medicines for OUD. It is also an opioid, but a much safer one. It can help reduce chronic pain, opioid cravings and more. It is often started in people who have already begun to recover from OUD. So starting buprenorphine in a doctor’s office is quite common.
But a new study in Addiction Science & Clinical Practice says doctors need to know something. Many of these patients are doing well. Yet they still have many mental health problems, including thoughts of suicide.
How common are suicidal thoughts in people starting buprenorphine?
This was a small study. Still, it shows how complex the topic is. OUD patients, even while recovering, still have a lot of pain and mental health problems. The study had 244 people who had started buprenorphine in the past month in an office or outpatient clinic. Of them, 37.7% reported suicidal thoughts, and 27.46% had a history of attempted suicide. So suicidal thoughts are widespread in OUD patients, even those seen as good candidates for starting buprenorphine.
The study also looked at what might be tied to suicidal thoughts. A past of physical abuse (4.31 times), chronic pain (3.28 times), depression (3.3 times) and anxiety (7.47 times) all raised the risk. Suicidal thoughts were also more common in Latinos.
The study has limits. It is still a small study. Even so, experts noted that it likely shows suicide risk on the low side. It left out people with psychosis, people who were intoxicated and people with severe mental health problems. So in real practice, rates of suicidal thoughts might be even higher.
Why should doctors check suicide risk before starting buprenorphine?
The study matters for both patients and doctors. Doctors need to know that suicidal thoughts are quite common in OUD patients. So when they start buprenorphine, they must also check suicide risk. The risk is especially high in people who were physically abused, have chronic pain, or have emotional disorders like anxiety and depression.
Patients can benefit by sharing their concerns with the doctor. Then the doctor can treat not only OUD but also other problems like chronic pain and anxiety.
This study also shows why good screening tools for suicide risk are needed.
Of course, these findings will not surprise pain medicine doctors. They are usually well aware of these issues and good at spotting such risks. Still, it is another reminder for pain specialists to check their patients carefully before starting buprenorphine. If needed, they should start treatment in the hospital.
Frequently asked questions
What is buprenorphine used for?
Buprenorphine is one of the most used medicines for opioid use disorder (OUD). It is an opioid, but a much safer one. It can help reduce chronic pain and opioid cravings. It is often started in an office or outpatient clinic for people who have already begun their recovery.
Does buprenorphine make you depressed?
The study on this page did not test whether buprenorphine causes depression. It found that many people starting buprenorphine already live with depression, anxiety and chronic pain. Depression raised the odds of suicidal thoughts about 3.3 times. Tell your doctor about low mood so it is treated along with OUD.
Who is most at risk of suicidal thoughts during opioid addiction treatment?
The study followed 244 adults who had started buprenorphine in the past month. The biggest risk factors were anxiety (7.47 times the risk), a past of physical abuse (4.31 times), depression (3.3 times) and chronic pain (3.28 times). Suicidal thoughts were also more common in Latino patients.
What should I tell my doctor before starting buprenorphine?
Share every concern, including pain, anxiety, low mood and any thoughts of suicide. That lets your doctor treat the opioid use disorder and the problems that come with it, such as chronic pain and anxiety. When the risk is high, it may be better to start treatment in the hospital.
Related reading
Buprenorphine Treatment Gaps Raise Overdose Risk · Methadone Reduces Treatment Dropout More Than Buprenorphine · Opioid Constipation: Why Laxatives Stop Working · Addiction Treatment FAQ
References
Lent, M. R., Dugosh, K. L., Hurstak, E., Callahan, H. R., Mazur, K., Festa, S., DeJoseph, D., DeJoseph, J., DeBates, R., Bulan, T., Harnett, A., van Riper, A., Millard, C., Wooten, H., Loscalzo, E., Leonard, M., Oojewoye, O., Festinger, D., Lavin, C., … The Greater Philadelphia Opioid Use Disorder Research Group. (2023). Prevalence and predictors of suicidality among adults initiating office-based buprenorphine. Addiction Science & Clinical Practice, 18(1), 37. https://doi.org/10.1186/s13722-023-00393-y