Suicidal ideations, attempts linked to opioid use and pain sensitivity in elderly

A new study published in the current issue of Psychotherapy and Psychosomatics suggests that suicidal ideations and suicide attempts are linked to opioid use and pain sensitivity in the elderly. The recent dramatic increase in opioid prescribing and their inappropriate use has led to an epidemic of opioid addictions, often generalizing to other substance use disorders and overdose deaths. In the US, the suicide death rate with opioid overdose increased from 2.2% in 1999 to 4.4% in 2010.

Authors investigated differences in terms of analgesic consumption and physical pain between (1) subjects with suicidal ideation during follow-up or with a lifetime history of suicide attempt, (2) affective controls, i.e., subjects with a lifetime history of major depression Mini-International Neuropsychiatric Interview (MINI) or high depressive symptoms (Center for Epidemiological Studies-Depression, CES-D >16) during the study but without suicidal ideations/attempts and (3) healthy controls, i.e., having neither suicidal ideations/attempts nor major depression, and having low depressive symptoms and no psychotropic medication use during the study.

The proportion of subjects taking analgesics was 37.6% in subjects with suicidal ideations/attempts, 30.2% in affective controls, and 21.6% in healthy controls. A higher rate of analgesic consumption in subjects with suicidal ideation/attempt versus healthy controls was reported. For nonopioid drugs, proportions were 21.8% in subjects with suicidal ideation/attempt, 18.5% in affective controls, and 15.5% in healthy controls; for opioid drugs, they were 15.7% in subjects with suicidal ideation/attempt, 11.7% in affective controls, and 6.1% in healthy controls. Also comparing nonopioid and opioid drug consumption, a difference between subjects with suicidal ideation/attempt and healthy controls was found. When compared opioid users to analgesic nonusers, subjects with suicidal ideation/attempt were more prone to use opioids than healthy controls (suicidal ideations/attempts: odds ratio (OR) = 2.78).

These findings point out to the increased consumption of opioids in subjects with suicidal ideation/attempt compared to healthy controls which might suggest an increased sensitivity to psychological and/or physical pain in suicide.