Suicide and self-harm among people prescribed opioid agonist treatment in New South Wales: A retrospective data linkage study

Author: Nicola Jones, Samantha Colledge-Frisby, Louisa Degenhardt, Michael Farrell, Jimmy Kwa, Prianka Padmanathan, Thomas Santo, Matthew Hickman, Natasa Gisev

Theme: Epidemiology & Public Health Research Year: 2023

Background: Rates of suicide and self-harm are elevated among people with opioid use disorder (OUD). This study examined incidence of self-harm and suicide among people who have entered OAT and assessed the impact of different OAT exposure periods on these events.

Methods: The cohort comprised of 45,664 people receiving OAT in New South Wales between 2002 and 2017. The linked data resource included OAT, hospital, mental health, and custodial information. Self-harm (i.e., non-fatal) and suicide (i.e., fatal) included intentional: overdose, cutting or piercing, violent or other methods.

Results: There were 7482 hospitalisations (4148 individuals) for self-harm and 556 suicides, equating to incidence rates of 19.2 (95% confidence intervals [CI]=18.8-19.7) and 1.0 (95%CI=0.9-1.1) per 1000 PY, respectively. Opioid overdose was implicated in
9.6% of suicides and 28% of self-harm hospitalisations. Compared to ≥29 days on OAT, the incidence rate of suicide was elevated in the 28 days following OAT cessation (ARR=17.4 [95%CI=11.7-25.9]), and the rate of self-harm hospitalisations was elevated during the first 28 days of OAT (ARR=2.2 [95%CI=1.9-2.6]) and the 28
days after leaving OAT (ARR=2.7 [95%CI=2.3-3.2]).

Conclusion: OAT may reduce suicide and self-harm risk among people with OUD; however, OAT initiation and cessation are critical periods for targeting self-harm and
suicide prevention interventions.

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