Observational studyBMJ (Clinical research ed.)2020
Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation.
Observational study in BMJ (Clinical research ed.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 129 papers, 7 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
129 citing papers in PubMed, 7 syntheses or guidelines pooled it, 233 citations in OpenAlex.
- Patient- and Clinician-Related Factors Associated With the Reduction in Opioid Use Among Adults With Chronic Non-Cancer Pain: A Systematic Review.Clinical pharmacology and therapeutics · 2026Pooled it
- Executive summary of the guideline for prescribing opioid analgesics for chronic non-cancer pain (third edition) by the Japan Society of Pain Clinicians.Journal of anesthesia · 2025Guideline
- Pooled it
- 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
- Pill Counting as an Intervention to Enhance Compliance and Reduce Adverse Outcomes with Analgesics Prescribed for Chronic Pain Conditions: A Systematic Review.Current pain and headache reports · 2022Pooled it
- CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022.MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports · 2022Guideline
- Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis.BMJ (Clinical research ed.) · 2022Pooled it
- What influences Australian pharmacists' decisions to supply opioids? Results from a survey and randomised controlled factorial experiment.Drug and alcohol review · 2025Trial
- Government Direct-to-Consumer Education to Reduce Prescription Opioid Use: A Cluster Randomized Clinical Trial.JAMA network open · 2024Trial
- The impact of race, gender, and heroin use on opioid addiction stigma.Journal of substance abuse treatment · 2022Trial
- A Cluster-Randomized Clinical Trial to Decrease Prescription Opioid Misuse: Improving the Safety of Opioid Therapy (ISOT).Journal of general internal medicine · 2022Trial
- The association between naloxone distribution, buprenorphine treatment and retention and incident high-risk opioid prescribing with opioid overdose death in Kentucky, Massachusetts, New York and Ohio, United States: An exploratory community-level cohort study of data from the HEALing Communities Study.Addiction (Abingdon, England) · 2026Observational
- Long-Term Opioid Therapy Tapering and Risk of Substance Use Disorder and Overdose: Differences by Opioid Dose and Duration.Journal of general internal medicine · 2026Article
- "Safer supply is the thing that changes everything": the role of prescribed safer supply in rebuilding trust following experiences of medical abandonment.BMC public health · 2026Article
- Primary care provider attitudes regarding physical therapists addressing opioid use and opioid misuse: a qualitative study.Physical therapy · 2026Article
- Impact of chiropractic care on opioid use for noncancer spine pain: systematic review and meta-analysis.Pain reports · 2026Review
- Prescription opioid discontinuation and mortality due to suicide or unintentional overdose.Pain · 2026Article
- Understanding Practitioner Comfort and Educational Priorities for Safe Opioid Prescribing: A Repeated Cross-Sectional Study.Journal of pain research · 2026Article
- The association between long-term opioid therapy and composite infection-related dental outcomes.PloS one · 2026Article
- The Association Between Rapid Opioid Dose Tapering and Polydrug Overdose Deaths Among High-Dose, Long-Term Opioid Therapy Recipients.Journal of general internal medicine · 2025Article
69 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
11 authors at 7 institutions in 2 countries.
Funding
Abstract
objectiveTo examine the associations between stopping treatment with opioids, length of treatment, and death from overdose or suicide in the Veterans Health Administration.
designObservational evaluation.
settingVeterans Health Administration.
participants1 394 102 patients in the Veterans Health Administration with an outpatient prescription for an opioid analgesic from fiscal year 2013 to the end of fiscal year 2014 (1 October 2012 to 30 September 2014).
main outcome measuresA multivariable Cox non-proportional hazards regression model examined death from overdose or suicide, with the interaction of time varying opioid cessation by length of treatment (≤30, 31-90, 91-400, and >400 days) as the main covariates. Stopping treatment with opioids was measured as the time when a patient was estimated to have no prescription for opioids, up to the end of the next fiscal year (2014) or the patient's death.
results2887 deaths from overdose or suicide were found. The incidence of stopping opioid treatment was 57.4% (n
conclusionsPatients were at greater risk of death from overdose or suicide after stopping opioid treatment, with an increase in the risk the longer patients had been treated before stopping. Descriptive data suggested that starting treatment with opioids was also a risk period. Strategies to mitigate the risk in these periods are not currently a focus of guidelines for long term use of opioids. The associations observed cannot be assumed to be causal; the context in which opioid prescriptions were started and stopped might contribute to risk and was not investigated. Safer prescribing of opioids should take a broader view on patient safety and mitigate the risk from the patient's perspective. Factors to address are those that place patients at risk for overdose or suicide after beginning and stopping opioid treatment, especially in the first three months.
Indexed as
Identifiers
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.