Opioid Prescribing and Suicide Risk in the United States

Objective: This study estimates associations of regional change in opioid prescribing with total suicide deaths and suicide overdose deaths involving opioids. Methods: A panel analysis was performed with 2009-2017 U.S. national IQVIA Longitudinal Prescription Database data and National Center for Health Statistics mortality data aggregated into commuting zones (N=8 86), which together span the United States. Opioid prescription ex-posures included opioid prescriptions per capita and percentages of patients with any opioid prescription, with high-dose prescriptions (>120 mg of morphine equiva-lents), with long-term prescriptions ($60 consecutive days), and with prescriptions from three or more pre-scribers. Linear regression models were used with year and commuting zone fixed effects. Results: Suicide deaths were significantly positively associ-ated with opioid prescriptions per capita (13=0.045), having any opioid prescription (13=0.069), having high-dose pre-scriptions (13=0.024), having long-term prescriptions (13=0.028), and having three or more opioid prescribers (13=0.046). Similar significant associations were observed between each of the five opioid prescription measures and suicide overdose deaths involving opioids (13 range, 0.029-0.042). However, opioid prescriptions per capita, having any opioid prescrip-tion, and having three or more opioid prescribers were each negatively associated with unintentional opioid-related deaths in people in the 10-to 24-year and 25-to 44-year age groups. Conclusions: In this retrospective study of U.S. commuting zone-level opioid prescriptions and mortality, regional de-creases in opioid prescriptions were consistently associated with declines in total suicide deaths, including suicide overdose deaths involving opioids. For some opioid pre-scribing measures, negative associations were observed with unintentional overdose deaths involving opioids among younger people. Individual-level inferences are limited by the ecological nature of the analysis.