301: Opioid Deprescribing and Suicide-Related Outcomes: A Systematic Review and Meta-Analysis

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Pharmacological treatments, Epidemiology, Treatment/management

Background and Aims: Evolving evidence on the risks and long-term benefits of opioid therapy, along with the opioid epidemic, has prompted widespread implementation of opioid deprescribing guidelines aiming to reduce opioid-related harms. However, emerging evidence suggests that opioid tapering or discontinuation may be associated with higher risk of suicide-related outcomes. We sought to synthesize the evidence evaluating the association between opioid deprescribing and composite suicide-related outcomes including suicidal ideation, suicide attempts, and suicide death among adults prescribed long-term opioid therapy.

Methods: Four electronic sources (MEDLINE, Embase, PsycINFO and Web of Science) were searched from inception until December 2025. Studies examining suicide-related outcomes following opioid deprescribing in adults prescribed long-term opioids (≥90 days) were included. Two reviewers independently screened articles, and extracted data on composite suicide-related outcomes, completed suicide, and suicide attempts. Risk of bias was assessed using ROBINS-I version 2. Random-effects meta-analysis was used to pool effect estimates when ≥2 studies were available. When studies reported multiple deprescribing strategies, discontinuation estimates were used for the primary analysis, with tapering examined in sensitivity analyses. Data analysis is ongoing; preliminary results are presented.

Results: Ten studies were included, most from the United States, and six contributed to meta-analysis. Opioid discontinuation showed a non-significant increase in composite suicide-related outcomes with substantial heterogeneity (OR 1.99, 95% CI 0.95–4.15; I² = 91%). Consistent findings were seen in sensitivity analyses, excluding outlier studies. Restricting to tapering studies, there was a small but statistically significant increase in composite suicide-related outcomes (OR 1.17, 95% CI 1.04–1.31). No significant associations were observed for suicide death (OR 0.94, 95% CI 0.69–1.29) or suicide attempts. Narrative synthesis suggested increased vulnerability for suicide during opioid deprescribing.

Conclusions: Pooled estimates showed no statistically significant association between opioid discontinuation and suicide-related outcomes, though heterogeneity limits certainty, while opioid tapering was associated with a small but statistically significant increase in composite suicide related outcomes. The findings support the need to incorporate suicide risk screening into opioid deprescribing. Future studies with standardized populations and outcome definitions are needed to inform safer deprescribing practices.

References: 1. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recommendations and Reports. 2022;71(3):1–95.

2. Oliva EM, Bowe T, Manhapra A, Kertesz S, Hah JM, Henderson P, Robinson A, Paik M, Sandbrink F, Gordon AJ. Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans. BMJ. 2020;368:m283.

3. Alam IZ, DiPrete BL, Pence BW, et al. Association between rapid opioid reduction or discontinuation and self-harm, suicide attempt, and suicide death among patients receiving high-dose, long-term opioid therapy in North Carolina, 2006–2018. American Journal of Epidemiology. 2025;194(8):2357–2366.

Presenting Author: Roger Knaggs
Submitting Author: Reham Baamer

Senior Author: Roger Knaggs

IASP 2026 Global Year theme of Neuropathic Pain: No

• Reham Baamer: Phd - Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, United Kingdom
• Alyaa Ajabnoor: PhD - Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
• James Musk - School of Health Sciences, University of Nottingham, Nottingham, UK
• Louise Wilson - Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, United Kingdom
• Rawan Almadfaa: PhD - Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
• Roger Knaggs: PhD - Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, United Kingdom ; Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK