Association between rapid opioid reduction or discontinuation and self-harm, suicide attempt, and suicide death among patients receiving high-dose, long-term opioid therapy in North Carolina, 2006-2018

We examined the association between rapid reduction or discontinuation of opioid therapy and self-harm, suicide attempt, and suicide death among patients receiving high-dose, long-term opioid therapy (HD-LTOT) and examined effect measure modification by individual and neighborhood-level characteristics. Using private insurance data from North Carolina, this retrospective cohort study covered January 2006 to September 2018, with up to 4 years of follow-up. Participants included patients aged 18-64 years who were prescribed HD-LTOT. The time-varying exposure was ever exposed to rapid opioid therapy reduction or discontinuation vs never exposed. The outcomes were self-harm or suicide attempt, suicide death, and the combined outcome. We estimated cumulative incidence and used Fine-Gray models to estimate sub-distribution hazard ratios (HRs). There were 21 450 patients prescribed HD-LTOT. In year 1, rapid opioid therapy reduction or discontinuation was not associated with the combined outcome (HR = 1.09; 95% CI, 0.61-1.96). However, in years 2-4, rapid opioid therapy reduction or discontinuation was associated with higher hazard of the combined outcome (HR = 2.77; 95% CI, 1.45-5.27). This association was stronger among patients with mental health conditions and those residing in underserved neighborhoods. These findings underscore the importance of provider training in adhering to guideline-concordant gradual tapering, offering mental health support, and ensuring patient safety throughout the tapering process.