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The Risk of Suicidal Behavior in Association with Starting Youth on an Opioid Prescription: How Much Should We Worry?

February 7, 2022

Although we all want to limit the use of opioids, they can play an important role in pain management. There has been some concern that use of opioids can increase future suicidal behavior. What is known about this risk?

Fine et al (10.1542/peds.2020-049750) analyzed Swedish population registry data that included 1.9 million youth and young adults between the ages of 9 and 29 who first received an opioid prescription prior in 2007 through 2013 and evaluated self-injurious behavior or death by suicide during this same time period. The authors identified 201,433 individuals with a new opioid prescription and found that when compared to matched youth who had not been given an opioid, opioid initiators had more than twice the overall risk of suicidal behavior within 5 years (2.9% vs 1.2%). The study also compared the risk to matched youths who were given non-steroidal anti-inflammatory drugs (NSAID) instead of opioids and found that the risk narrowed (2.2% vs. 1.9%). This translates to an additional 3 individuals with opioid use out of 1,000 in the population of having more suicidal behaviors. The study did not find a difference in risk by type or dose of opioids. Given this low additional risk, should we worry less about prescribing opioids? The answer remains a “no” from the authors, and I’m sure from readers like yourself as well. There are many other reasons to avoid opioids that just because they may play a small role in suicidal behaviors is not sufficient to reconsider more liberal use of them after minor surgical and dental procedures. I would prescribe you link to the study and learn more.

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