Huang Shu, Jiao Tianze, Guo Serena Jingchuan, Star Jill A, Bian Jiang, Wilson Debbie L, Goodin Amie J
Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA.
Pain Med. 2025 Apr 10. doi: 10.1093/pm/pnaf044.
CDC guidelines highlight the increased suicide risk associated with abrupt discontinuations of long-term opioid therapy (LTOT). However, evidence on specific dose and duration "thresholds" of LTOT for suicide risk is limited. We aimed to identify opioid dose trajectories before abrupt LTOT discontinuations and their association with 6-month suicide risk.
This retrospective cohort study analyzed 2016-2021 Florida Medicaid claims for adult non-cancer beneficiaries with abrupt LTOT discontinuation, defined as having a > 15-day gap in opioid supply after ≥90 consecutive days of use. We assessed prescription opioid doses as the mean weekly morphine-milligram equivalent (MME) six months preceding the first abrupt LTOT discontinuation. Group-based trajectory modeling identified distinct opioid trajectory patterns, and multivariable Cox proportional hazards models examined associations between trajectory groups and a composite outcome of suicidal ideation, non-fatal suicide attempts, and suicide death six months following the abrupt LTOT discontinuation.
Among 15,680 beneficiaries (mean age:46.2±11.1 years; 60.8% female), four trajectory groups based on weekly MMEs: low (<25: n = 8814, 56.2%), moderate (25-50: n = 4313, 27.5%), high (51-150: n = 1452, 9.3%), and very-high (>150: n = 1101, 7.0%) were identified. Compared with the low-dose group, the very-high dose group had a significantly higher risk of suicide-related outcomes [adjusted hazard ratio (aHR): 2.2, 95% confidence interval (95%CI):1.3-3.6], while the moderate and high dose groups had similar risks (moderate: aHR=1.3, 95%CI:0.9-1.8, high: aHR=0.7, 95%CI:0.4-1.3).
Among Florida Medicaid beneficiaries with LTOT, very-high opioid doses (>150 weekly MME) in the six months preceding an abrupt LTOT discontinuation were associated with an increased risk of suicide-related outcomes.
美国疾病控制与预防中心（CDC）的指南强调了长期阿片类药物治疗（LTOT）突然中断所带来的自杀风险增加。然而，关于LTOT导致自杀风险的具体剂量和持续时间“阈值”的证据有限。我们旨在确定突然中断LTOT之前的阿片类药物剂量轨迹及其与6个月自杀风险的关联。
这项回顾性队列研究分析了2016 - 2021年佛罗里达州医疗补助计划中成年非癌症受益人的申请，这些受益人LTOT突然中断，定义为在连续使用阿片类药物≥90天后，阿片类药物供应出现超过15天的中断。我们将首次突然中断LTOT前六个月的处方阿片类药物剂量评估为平均每周吗啡毫克当量（MME）。基于组的轨迹模型确定了不同的阿片类药物轨迹模式，多变量Cox比例风险模型检验了轨迹组与LTOT突然中断后六个月自杀意念、非致命自杀未遂和自杀死亡的复合结局之间的关联。
在15,680名受益人中（平均年龄：46.2±11.1岁；60.8%为女性），根据每周MME确定了四个轨迹组：低剂量组（<25：n = 8814，56.2%）、中等剂量组（25 - 50：n = 4313，27.5%）、高剂量组（51 - 150：n = 1452，9.3%）和极高剂量组（>150：n = 1101，7.0%）。与低剂量组相比，极高剂量组自杀相关结局的风险显著更高[调整后风险比（aHR）：2.2，95%置信区间（95%CI）：1.3 - 3.6]，而中等剂量组和高剂量组的风险相似（中等剂量组：aHR = 1.3，95%CI：0.9 - 1.8；高剂量组：aHR = 0.7，95%CI：0.4 - 1.3）。
在佛罗里达州接受LTOT的医疗补助受益人中，LTOT突然中断前六个月的极高阿片类药物剂量（每周MME>150）与自杀相关结局的风险增加有关。
