High-Risk Opioid Use May Be Linked to Self-Medication in Schizophrenia

Overdose of pills
Overdose of pills
Researchers compared death records with the prior diagnosis of schizophrenia for decedents in Wales, finding what they believe is a high-risk for accidental overdose in patients with schizophrenia who self-medicate with opioids.

According to a study of opioid overdoses published in Psychiatry Research, more than 6% of deaths were attached to diagnoses of schizophrenia or schizotypal disorder; however, most of these deaths were accidental, raising questions about opioid misuse to self-medicate. The investigators of this autopsy study sought to examine the prevalence of schizophrenia among high-risk opioid users during a 36-month observation period prior to overdose death.

Researchers identified a sample of 312 decedents of opioid overdose who died in Wales between January 2012 and December 2015. Linking mortality records with hospital and general practice datasets, researchers applied a coding framework to capture schizophrenic episodes recorded in Welsh National Health Service primary care services. The researchers analyzed diagnostic codes related to schizophrenia and depression attached to decedents’ records during a high-risk period of 36 months prior to their death from overdose.

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Spanning the 36 months prior to their deaths, researchers found that 1 or more International Statistical Classification of Diseases and Related Health Problems 10th revision and Read Clinical Terms Version 2 diagnostic codes related to schizophrenia were attached to 19 decedents (6.09%). Of these 19 decedents, 17 died from accidental overdose, whereas 2 were of undetermined intent. When the researchers stratified data by year, the number of overdose deaths in which the decedents were identified with schizophrenia or schizotypal disorder increased over the course of the study period from 2012 to 2015. For context, 28 (8.97%) decedents in the sample were diagnosed with depressive disorder during the 3-year period prior to death.

The investigators suggest that although most deaths from overdose were found to be accidental, further research should address high-risk opioid use in patients with schizophrenia and specific treatment pathways for opioid misuse in this patient population.

This study was sponsored by the Wales Centre for Primary and Emergency Care Research.


Watkins A, John A, Bradshaw C, Jones J, Jones M. Schizophrenia in high risk opioid users: a short communication on an autopsy studyPsychiatry Res. 2019; 276:112-114.