Association Between Opioid and Benzodiazepine Misuse and Suicidal Ideation

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Past-year misuse of 1 medication class, either opioids or benzodiazepines, was associated with an approximate 6% increase in suicidal ideation.
Past-year misuse of 1 medication class, either opioids or benzodiazepines, was associated with an approximate 6% increase in suicidal ideation.

The misuse of opioid and benzodiazepine medication is associated with increased odds of suicidal ideation, according to a study published in the International Journal of Geriatric Psychiatry.

Using data from adults aged 50 years and older from the 2015 to 2016 National Survey on Drug Use and Health, investigators sought to determine whether opioid and benzodiazepine use and misuse were associated with past-year suicidal ideation. All participants were asked the following question: "At any time in the past 12 months, that is from [date 12 months ago inserted] up to and including today, did you seriously think about trying to kill yourself?" Participants were then categorized in relation to use, misuse, and no past-year use.

After adjusting for control variables (sociodemographic, physical health, mental health, and substance use), the researchers recorded a significant association between both benzodiazepine misuse (adjusted odds ratio, 2.00; 95% CI, 1.01-3.94; P =.046) and opioid misuse (adjusted odds ratio, 1.84; 95% CI, 1.07-3.19; P =.03) and past-year suicidal ideation in older adults. Adults reporting misuse of both drugs reported a notably higher rate of past-year suicidal ideation (25.4%) than those reporting either opioid misuse (8.3%) or benzodiazepine misuse (8.8%) on their own. The researchers noted that "clinically, these results further reinforce that benzodiazepine use in older adults should be generally avoided," especially given the recent finding that "roughly 22% of US older adults had used a benzodiazepine in the past year."

The researchers indicate that although the data are cross-sectional, the relationship between suicidal ideation and prescription drug misuse could have been related through a third factor (eg, internalizing psychopathology). In addition, the limited availability of variables, especially those related to pain and physical health, may have influenced the results. There was a possibility of self-report bias; however, steps were taken to reduce this during interviews. Finally, the researchers note that it is likely that older adults in nonhousehold settings were undersampled.

Investigators found a significantly increased risk for suicidal ideation among those who reported misusing opioid or benzodiazepine medication, and especially those who reported misusing both. The researchers suggest that these findings point to the importance both of screening older adults for opioid and benzodiazepine misuse and also of screening those who show signs of misuse for suicidal ideation.

Reference

Schepis TS, Simoni-Wastila L, McCabe SE. Prescription opioid and benzodiazepine misuse is associated with suicidal ideation in older adults [published online October 16, 2018]. Int J Geriatr Psychiatry. doi: 10.1002/gps.4999

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