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Oxycodone, Hydromorphone, and the Risk of Suicide: A Retrospective Population-Based Case–Control Study

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Abstract

Introduction

Opioids have been increasingly associated with suicide, but whether they are independent contributors is unclear. Oxycodone and hydromorphone are commonly prescribed high-potency opioids that can differentially affect mood.

Objective

The objective of this study was to explore whether oxycodone and hydromorphone are differentially associated with suicide.

Methods

We conducted a retrospective population-based case-control study in Ontario, Canada, from 1992 to 2014. Using coronial data, we defined case subjects as individuals who died by suicide involving an opioid overdose. Each of these was matched with up to four controls who died of accidental opioid overdose. We ascertained exposure to oxycodone, hydromorphone, and other opioids from postmortem toxicology testing. We used odds ratios and 95% confidence intervals to examine whether opioid-related suicide was disproportionately associated with oxycodone relative to hydromorphone.

Results

We identified 438 suicides and 1212 accidental deaths, each of which involved either oxycodone or hydromorphone but not both. The median age at death was 49 years and 51% were men. After adjusting for a history of self-harm, psychiatric illness, and exposure to other opioids, we found that oxycodone was more strongly associated with suicide than hydromorphone (adjusted odds ratio 1.59; 95% confidence interval 1.20–2.11). In a secondary analysis, we observed a trend of similar magnitude in which combined exposure to oxycodone and hydromorphone was more strongly associated with suicide than hydromorphone alone (adjusted odds ratio 1.68; 95% confidence interval 0.92–3.09).

Conclusions

While preliminary, these findings support the possibility that some high-potency opioids might independently influence the risk of suicide in susceptible individuals.

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Acknowledgements

We thank the Office of the Chief Coroner for Ontario, which, as part of their public safety mandate, made available the relevant data on opioid-related deaths in Ontario. We also thank Tilley Creary for assistance with manuscript preparation.

Author information

Authors and Affiliations

  1. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

    Graham Mazereeuw

  2. Li Ka Shing Knowledge Institute, Toronto, ON, Canada

    Tara Gomes

  3. The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Erin M. Macdonald, Simon Greaves, Ping Li & David N. Juurlink

  4. Li Ka Shing Centre for Healthcare Analytics Research and Training, Toronto, ON, Canada

    Muhammad M. Mamdani

  5. Sunnybrook Research Institute, Toronto, ON, Canada

    Donald A. Redelmeier

  6. Sunnybrook Health Sciences Centre, 2075 Bayview Avenue G106, Toronto, ON, M4N 3M5, Canada

    David N. Juurlink

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  1. Graham Mazereeuw
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  3. Erin M. Macdonald
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Corresponding author

Correspondence to David N. Juurlink.

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Funding

This study was supported by the Ontario Drug Policy Research Network (ODPRN), which is funded by a grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The ODPRN is also funded by the Ontario Strategy for Patient-Orientated Research (SPOR) Support Unit, which is supported by the Canadian Institutes of Health Research and the Province of Ontario. This study was also supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario MOHLTC. Datasets provided by ICES were linked using unique encoded identifiers and analyzed at ICES. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication. The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES, the SPOR Unit, or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the author, and not necessarily those of CIHI.

Conflict of interest

Graham Mazereeuw, Tara Gomes, Ping Li, Simon Greaves, Erin M. Macdonald, and Donald A. Redelmeier have no conflicts of interest that are directly relevant to the content of this study. Muhammad M. Mamdani has served as an advisory board member for the following pharmaceutical companies: Allergan, AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Company, Hoffman La Roche, Novartis, and Novo Nordisk. David N. Juurlink is a member of Physicians for Responsible Opioid Prescribing (PROP; https://www.supportprop.org/), a volunteer organization with the goal of promoting safer opioid prescribing.

Data sharing

The datasets generated and/or analyzed during the current study are not publicly available as some participants may be identifiable by unique demographic or medical characteristics. The datasets may be available from the corresponding author on reasonable request.

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Mazereeuw, G., Gomes, T., Macdonald, E.M. et al. Oxycodone, Hydromorphone, and the Risk of Suicide: A Retrospective Population-Based Case–Control Study. Drug Saf 43, 737–743 (2020). https://doi.org/10.1007/s40264-020-00924-5

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