Summary: Buprenorphine is a treatment of choice for treating opioid use disorder (OUD) in outpatient settings. However, doctors need to understand that many such patients have suicidal thoughts. Studies victims of physical abuse, those living with chronic pain, anxiety, and depression are more likely to have suicidal thoughts.
Fortunately, opioid use disorder (OUD) rates have started declining in the US, thanks to more responsible opioid use in clinical practice. Nevertheless, OUD will remain a significant issue in the foreseeable future.
Many of those living with OUD are also living with mood disorders and acute and chronic pain. In fact, many started using opioids to overcome chronic pain and mental distress, and they later became opioid-addicted. Hence, when managing OUD patients, these factors must be kept in mind.
Buprenorphine is one of the most commonly used medications to manage OUD. It is also an opioid, but a much safer opioid. It can help reduce chronic pain, opioid cravings, and more. This medication is frequently initiated in those who have already started making a recovery from OUD. Hence, office-based buprenorphine therapy initiation is pretty common.
However, a new study published in Addiction Science & Clinical Practice says that doctors need to understand that though many of these patients are making good recovery, they still have many mental health issues, including suicidal thoughts.
Predictors and Prevalence of Suicidal Thoughts in Buprenorphine Initiators
Though this was a small study, it still demonstrates the complexity of the topic, showing that OUD patients, even in their recovery phase, are still experiencing much pain and mental health issues. The study had 244 participants in whom buprenorphine was initiated in the past month in an office setting or outpatient department. Out of them, 37.7% reported having suicidal thoughts, and 27.46% had a history of attempted suicide. This shows that suicidal thoughts are widely prevalent in OUD patients and are generally regarded as good for initiating buprenorphine.
The study also explored the factors that might be associated with suicidal thoughts. It found that a history of physical abuse (4.31 times), chronic pain (3.28 times), depression (3.3 times), and anxiety (7.47 times) increased the risk of suicidal thoughts. Further, suicidal thoughts were more common among Latinos.
The study has some limitations, such as it is still a small study. Nonetheless, experts noticed that this study reported suicide risk on a lower side. It did not include in the study those who have psychosis, intoxication, or severe mental health issues. Thus, in practice, suicide ideation rates might be even higher.
The Bottom line
The study has some implications for both the patients and doctors. Doctors need to understand that suicide ideation is pretty common in OUD patients. Thus, when they are starting buprenorphine, they must also assess suicide risk. This risk is especially high in those who were victims of physical abuse, have chronic pains, and emotional disorders like anxiety and depression.
When it comes to patients, they can benefit by sharing information about their concerns with the doctor. This will ensure that the doctor not only treats OUD but also provides treatment for other conditions like chronic pain and anxiety.
This study also highlights the importance of creating effective patient screening tools for suicide risk.
Sure, these findings are not a surprise for pain medicine providers. They are generally well aware of such issues and are good at identifying such risks. Nonetheless, this is just another reminder for pain medicine specialist to carefully evaluate their patients before initiating buprenorphine and, if needed, better start with inpatient treatment.
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
