Pain, Substance Use Disorder and Suicide: on the Edge

Abstract Purpose of Review Chronic pain and substance use disorders (SUDs) are both common conditions worldwide and produce major social, economic, and human costs. Individuals coping with chronic pain and comorbid SUD may experience high rates of stress, isolation, functional decline, and depression, and many have a high risk of suicide. The purpose of this narrative review is to highlight the hidden epidemic of suicide among individuals with pain and concomitant SUD, outline unique risk factors in this patient population, and discuss evidence-based pharmacologic and non-pharmacologic interventions to mitigate suicide risk. Recent Findings The prevalence of suicidal ideation among patients with chronic non-cancer pain (CNCP) is significant, ranging from 20 to 50%. It has been estimated that 40% of patients seeking treatment for SUDs report a history of suicide attempts. Risk factors for suicide in populations with CNCP pain include pain intensity and type, sleep disturbance, opioid prescribing patterns and opioid tapering. Evidence-based pharmacologic treatments include antidepressant medications, antiepileptic drugs and more novel drugs such as ketamine and buprenorphine. Non-pharmacologic approaches, such as cognitive behavioral therapy and acceptance commitment therapy, have shown efficacy in improving mood, sleep and function. Summary There is a high rate of suicide among individuals with CNCP and SUDs. Identifying unique contributing factors for suicide among this vulnerable patient population can inform effective interventions to reduce the risk of suicide.