Opioid use disorder of any severity is associated with increased suicidality

BACKGROUND: Suicide represents an underappreciated contributor to drug-related mortality, with 20%-30% of opioid overdoses estimated to be intentional. However, suicide risk relative to opioid use disorder (OUD) severity has not been well characterized. Understanding suicidality risk across the OUD severity spectrum will inform which healthcare providers should be screening and treating self-harm. METHODS: We estimated the odds of past-year suicidal thoughts, plans, and attempts relative to OUD severity using data from the National Survey on Drug Use and Health (NSDUH), a cross-sectional, nationally representative, population-based survey study of noninstitutionalized individuals. Data were analyzed for adults (18+) from 2021 to 2023 (N = 139,524). Past-year DSM-5 OUD, OUD severity, and past-year suicidal thoughts, plans, and attempts were estimated, and logistic regression was utilized to assess the association of OUD severity with suicidality measures. RESULTS: Among individuals with OUD, 62.9% (95% CI, 60.1%-65.6%) had mild, 15.9% (95% CI, 13.5%-18.6%) had moderate, and 21.2% (95% CI, 19.1%-23.6%) had severe OUD. Individuals with OUD were at increased odds of reporting suicidal thoughts compared to individuals without OUD: mild OUD was associated with 2.18-fold greater odds (95% CI, 1.61-2.95), moderate OUD was associated with 1.88-fold greater odds (95% CI, 1.08-3.28), and severe OUD was associated with 4.17-fold greater odds (95% CI, 2.99-5.82). Individuals with OUD were also at increased odds of reporting a suicide plan relative to no OUD: mild OUD was associated with 3.35-fold greater odds (95% CI, 2.07-5.41), moderate OUD was associated with 4.66-fold greater odds (95% CI, 2.66-8.17), and severe OUD was associated with 6.70-fold greater odds (95% CI, 4.59-9.75). Lastly, across OUD severities, there was an increased odds of reporting a suicide attempt relative no OUD: mild OUD was associated with 2.80-fold greater odds (95% CI, 1.53-5.13), moderate OUD was associated with 8.45-fold greater odds (95% CI, 3.28-21.8), and severe OUD was associated with 9.96-fold greater odds (95% CI, 5.52-18.0). CONCLUSIONS: These findings suggest OUD of any severity is associated with markedly increased risk of suicidal thoughts, plans, and suicide attempts. This highlights a continued need to integrate suicide screening and prevention into OUD treatment and clinical settings where opioids are frequently prescribed, such as primary care.