Suicidal ideation in adults with opioid use disorder treated with buprenorphine-naloxone versus extended-release naltrexone.

Depression and suicidal ideation are prevalent in patients with opioid use disorder (OUD). This study examined changes in suicidal ideation during OUD treatment with buprenorphine-naloxone or extended-release naltrexone. 570 adults with OUD (29.6% female) were recruited into a National Drug Abuse Clinical Trials Network randomized trial (NCT02032433) comparing extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT). Suicidal ideation was assessed at baseline and regular intervals over 24 weeks using continuous self-reported and binary clinician-rated measures from the Concise Health Risk Tracking-Self Report and the Hamilton Depression Rating Scale, respectively. A mixed-effects model was used to assess the association between continuous outcome self-reported suicidal ideation and treatment over time while adjusted for baseline suicidal ideation. Continuous self-report suicidal ideation scores decreased in both groups with a significant time-by-treatment interaction indicating that the treatment effect differed over time (F = 1.81,  = .0464). Scores were significantly lower in the buprenorphine group only in weeks 1 and 3 and when averaged across weeks 1-4. Binary clinician-rated suicidal ideation dropped from 15 (5.25%) and 12 (4.24%) at baseline, to 5 (1.89%) and 3 (1.49%) at week 1, for buprenorphine and naltrexone groups, respectively. OUD treatment with extended-release naltrexone or buprenorphine-naloxone was associated with suicidal ideation reductions from the first week. Suicidal ideation was lower with buprenorphine-naloxone in the first 4 weeks, with no significant differences thereafter. Despite overall low suicidal ideation scores and modest differences, these findings suggest beneficial effects of both treatments in individuals with OUD and mild baseline suicidality.