Citation

Molero Y, Zetterqvist J, Binswanger IA, Hellner C, Larsson H, Fazel S. Am. J. Psychiatry 2018; 175(10): 970-978.

Affiliation

From the Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; the Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan, Stockholm; the Institute for Health Research, Kaiser Permanente Colorado, Denver; the Division of General Internal Medicine, University of Colorado School of Medicine, Aurora; and the School of Medical Sciences, Örebro University, Örebro, Sweden.

Copyright

(Copyright © 2018, American Psychiatric Association)

DOI

10.1176/appi.ajp.2018.17101112

PMID

30068260

Abstract

OBJECTIVE: The authors examined associations between medications for alcohol and opioid use disorders (acamprosate, naltrexone, methadone, and buprenorphine) and suicidal behavior, accidental overdoses, and crime.

METHOD: In this total population cohort study, 21,281 individuals who received treatment with at least one of the four medications between 2005 and 2013 were identified. Data on medication use and outcomes were collected from Swedish population-based registers. A within-individual design (using stratified Cox proportional hazards regression models) was used to compare rates of suicidal behavior, accidental overdoses, and crime for the same individuals during the period when they were receiving the medication compared with the period when they were not.

RESULTS: No significant associations with any of the primary outcomes were found for acamprosate. For naltrexone, there was a reduction in the hazard ratio for accidental overdoses during periods when individuals received treatment compared with periods when they did not (hazard ratio=0.82, 95% CI=0.70, 0.96). Buprenorphine was associated with reduced arrest rates for all crime categories (i.e., violent, nonviolent, and substance-related) as well as reduction in accidental overdoses (hazard ratio=0.75, 95% CI=0.60, 0.93). For methadone, there were significant reductions in the rate of suicidal behaviors (hazard ratio=0.60, 95% CI=0.40-0.88) as well as reductions in all crime categories. However, there was an increased risk for accidental overdoses among individuals taking methadone (hazard ratio=1.25, 95% CI=1.13, 1.38).

CONCLUSIONS: Medications currently used to treat alcohol and opioid use disorders also appear to reduce suicidality and crime during treatment.

Language: en

Keywords

Alcohol Abuse; Epidemiology; Psychoactive Substance Use Disorder; Suicide; Violence/Aggression