ArticlePain2016
Opioid dose and risk of suicide.
Article in Pain, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 80 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
80 citing papers in PubMed, 3 syntheses or guidelines pooled it, 160 citations in OpenAlex.
- Predictors of fatal and nonfatal overdose after prescription of opioids for chronic pain: a systematic review and meta-analysis of observational studies.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023Pooled it
- A Systematic Review of Risk Factors for Suicide Among Persons Living with HIV (1996-2020).AIDS and behavior · 2022Pooled it
- Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers.Topics in spinal cord injury rehabilitationGuideline
- A randomized trial comparing the Tennant Biomodulator to transcutaneous electrical nerve stimulation and traditional Chinese acupuncture for the treatment of chronic pain in military service members.Military Medical Research · 2019Trial
- Attenuation of antidepressant and antisuicidal effects of ketamine by opioid receptor antagonism.Molecular psychiatry · 2019Trial
- Polymorphism A118G of opioid receptor mu 1 (OPRM1) is associated with emergence of suicidal ideation at antidepressant onset in a large naturalistic cohort of depressed outpatients.Scientific reports · 2019Trial
- Associations of Cannabis and Tobacco Use With Suicide Attempt, Suicide Death, and Overdose Death Among Veterans Prescribed Opioid Analgesics.American journal of preventive medicine · 2026Article
- Relationship of prescription and nonprescription opioid use, opioid misuse, and alcohol use with suicidal ideation among people with spinal cord injury.Spinal cord · 2026Article
- "I Am Reluctant to Continue, Yet Know She Could Go into Withdrawal": A Qualitative Analysis of Clinician Requests for eConsults in Opioid Management in the Ambulatory Setting.Journal of general internal medicine · 2026Article
- High-risk emergency department visits and risk of all-cause mortality, suicide, and fatal overdose among US military veterans.American journal of epidemiology · 2026Article
- Association Between Opioid Analgesics and Suicide Attempts: A Nationwide French Case-Crossover Study.CNS drugs · 2025Observational
- Mortality Risks of U.S. Healthcare Workers.American journal of preventive medicine · 2025Article
- Associations of medical outcomes with substances involved in suicide attempt cases age 50 and older reported to U.S. Poison Centers, 2016-2023.Frontiers in public health · 2025Observational
- Phenome-wide diagnostic comparison among suicide deaths and living individuals with chronic pain diagnoses.BMC medicine · 2024Article
- Suicide risk identification and mitigation in patients with chronic pain prescribed opioid medication.The mental health clinician · 2024Article
- Intersection of adverse childhood experiences, suicide and overdose prevention.Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention · 2024Review
- Article
- Machine learning identifies risk factors associated with long-term opioid use in fibromyalgia patients newly initiated on an opioid.RMD open · 2024Article
- Prenatal opioid use as a predictor of postpartum suicide attempts among reproductive-age women enrolled in Oregon Medicaid.BMC women's health · 2024Article
- Suicidal ideation in female individuals with fibromyalgia and comorbid obesity: prevalence and association with clinical, pain-related, and psychological factors.Pain medicine (Malden, Mass.) · 2024Article
20 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 1 institution in 2 countries.
Funding
Abstract
Chronic pain is associated with increased risk of suicide, and opioids are commonly used to treat moderate to severe pain. However, the association between opioid dose and suicide mortality has not been examined closely. This retrospective data analysis described the risk of suicide associated with differing prescribed opioid doses. Data were from Veterans Affairs health care system treatment records and the National Death Index. Records analyzed were those of Veterans Affairs patients with chronic pain receiving opioids in fiscal years 2004 to 2005 (N = 123,946). Primary predictors were maximum prescribed morphine-equivalent daily opioid dose and opioid fill type. The main outcome measured was suicide death, by any mechanism, and intentional overdose death during 2004 to 2009. Controlling for demographic and clinical characteristics, higher prescribed opioid doses were associated with elevated suicide risk. Compared with those receiving ≤20 milligrams/day (mg/d), hazard ratios were 1.48 (95% confidence intervals [CI], 1.25-1.75) for 20 to <50 mg/d, 1.69 (95% CI, 1.33-2.14) for 50 to <100 mg/d, and 2.15 (95% CI, 1.64-2.81) for 100+ mg/d. The magnitude of association between opioid dose and suicide by intentional overdose was not substantially different from that observed for the overall measure of suicide mortality. Risk of suicide mortality was greater among individuals receiving higher doses of opioids, and treatment providers may want to view high opioid dose as a marker of elevated risk for suicide. Additional research is needed on opioid use, pain treatment, and suicide.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.