Abstract
Background: Rates of suicide and self-harm are elevated among people with opioid use disorder (OUD). This study examined incidence of self-harm and suicide among people who have entered OAT and assessed the impact of different OAT exposure periods on these events.
Method: We conducted a retrospective population-based cohort study of all OAT
recipients (N=45,664) in New South Wales, Australia (2002-2017), using linked
administrative data. Incidence rates of self-harm hospitalisations and suicide deaths were estimated per 1000 person-years (PY). The first 28 days of an OAT episode, ≥29 days on OAT, the first 28 days off OAT, and ≥29 days off OAT (maximum four years post-OAT) were exposure periods. Poisson regression models with generalised estimating equations estimated the adjusted incidence rate ratios (ARR) of self-harm and suicide by OAT exposure periods, adjusting for covariates.
Results: There were 7482 hospitalisations (4148 individuals) for self-harm and 556 suicides, equating to incidence rates of 19.2 (95% confidence intervals [CI]=18.8-19.7) and 1.0 (95%CI=0.9-1.1) per 1000 PY, respectively. Opioid overdose was implicated in 9.6% of suicides and 28% of self-harm hospitalisations. Compared to ≥29 days on OAT, the incidence rate of suicide was elevated in the 28 days following OAT cessation (ARR=17.4 [95%CI=11.7-25.9]), and the rate of self-harm hospitalisations was elevated during the first 28 days of OAT (ARR=2.2 [95%CI=1.9-2.6]) and the 28 days after leaving OAT (ARR=2.7 [95%CI=2.3-3.2]).
Conclusions: OAT may reduce suicide and self-harm risk among people with OUD; however, OAT initiation and cessation are critical periods for targeting self-harm and suicide prevention interventions.
Method: We conducted a retrospective population-based cohort study of all OAT
recipients (N=45,664) in New South Wales, Australia (2002-2017), using linked
administrative data. Incidence rates of self-harm hospitalisations and suicide deaths were estimated per 1000 person-years (PY). The first 28 days of an OAT episode, ≥29 days on OAT, the first 28 days off OAT, and ≥29 days off OAT (maximum four years post-OAT) were exposure periods. Poisson regression models with generalised estimating equations estimated the adjusted incidence rate ratios (ARR) of self-harm and suicide by OAT exposure periods, adjusting for covariates.
Results: There were 7482 hospitalisations (4148 individuals) for self-harm and 556 suicides, equating to incidence rates of 19.2 (95% confidence intervals [CI]=18.8-19.7) and 1.0 (95%CI=0.9-1.1) per 1000 PY, respectively. Opioid overdose was implicated in 9.6% of suicides and 28% of self-harm hospitalisations. Compared to ≥29 days on OAT, the incidence rate of suicide was elevated in the 28 days following OAT cessation (ARR=17.4 [95%CI=11.7-25.9]), and the rate of self-harm hospitalisations was elevated during the first 28 days of OAT (ARR=2.2 [95%CI=1.9-2.6]) and the 28 days after leaving OAT (ARR=2.7 [95%CI=2.3-3.2]).
Conclusions: OAT may reduce suicide and self-harm risk among people with OUD; however, OAT initiation and cessation are critical periods for targeting self-harm and suicide prevention interventions.
| Original language | English |
|---|---|
| Article number | 109851 |
| Journal | Drug and Alcohol Dependence |
| Volume | 246 |
| Early online date | 23 Mar 2023 |
| DOIs | |
| Publication status | Published - 5 Apr 2023 |
Bibliographical note
Funding Information:The OATS study is funded by the National Institutes of Health (R01 DA144740 PI: Degenhardt). The National Drug Research Institute and the National Drug and Alcohol Research Centre are supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program.We acknowledge the contribution of the OATS study team. Data was provided and linkage was conducted by the Australian Institute of Health and Welfare, NSW Ministry of Health, Centre for Health Record Linkage, and Bureau of Crime Statistics and Research. We also acknowledge the support and expertise of the OATS Study Aboriginal Advisory Group in reviewing this manuscript. The authors wish to acknowledge all data custodians for providing access to the datasets used in this study. We acknowledge the contribution of the OATS study team. Data was provided and linkage was conducted by the Australian Institute of Health and Welfare, NSW Ministry of Health, Centre for Health Record Linkage, and Bureau of Crime Statistics and Research. We also acknowledge the support and expertise of the OATS Study Aboriginal Advisory Group in reviewing this manuscript. The authors wish to acknowledge all data custodians for providing access to the datasets used in this study. SCF is supported by the National Drug Research Institute. LD is supported by an Australian NHMRC Senior Principal Research Fellowship (#1135991) and a US National Institutes of Health (NIH) National Institute on Drug Abuse grant (R01DA1104470). PP is funded by the Medical Research Council Addiction Research Clinical Training Programme (MR/N00616X/1). MH acknowledges funding from National Institute of Health Research (NIHR) Health Protection Research Unit in Behavioural Sciences and Evaluation, NIHR Bristol Biomedical Research Centre at Bristol, NIHR School for Public Health Research, and NIHR EPIToPe. NJ acknowledges funding from the ASCEND program grant (GNT 1150078). In the past three years, LD and MF have received investigator-initiated untied educational grants for studies of opioid medications in Australia from Indivior and Seqirus. All other authors have no conflicts of interest to declare.
Funding Information:
The OATS study is funded by the National Institutes of Health ( R01 DA144740 PI: Degenhardt). The National Drug Research Institute and the National Drug and Alcohol Research Centre are supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program.
Funding Information:
We acknowledge the contribution of the OATS study team. Data was provided and linkage was conducted by the Australian Institute of Health and Welfare, NSW Ministry of Health, Centre for Health Record Linkage, and Bureau of Crime Statistics and Research. We also acknowledge the support and expertise of the OATS Study Aboriginal Advisory Group in reviewing this manuscript. The authors wish to acknowledge all data custodians for providing access to the datasets used in this study. SCF is supported by the National Drug Research Institute. LD is supported by an Australian NHMRC Senior Principal Research Fellowship (# 1135991 ) and a US National Institutes of Health (NIH) National Institute on Drug Abuse grant ( R01DA1104470 ). PP is funded by the Medical Research Council Addiction Research Clinical Training Programme ( MR/N00616X/1 ). MH acknowledges funding from National Institute of Health Research (NIHR) Health Protection Research Unit in Behavioural Sciences and Evaluation, NIHR Bristol Biomedical Research Centre at Bristol, NIHR School for Public Health Research , and NIHR EPIToPe. NJ acknowledges funding from the ASCEND program grant (GNT 1150078 ).
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© 2023 Elsevier B.V.
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