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UAB team investigates suicide, opioid prescription changes

In a new study, University of Alabama at Birmingham investigators will recruit family members of people who have died by suicide after a change in prescribed pain medications and survey their experiences.

In the United States, suicide rates rose 33 percent from 1999 to 2017, prompting actions by government and nongovernmental agencies, including a new suicide prevention hotline. There is no single explanation for that rise in suicides. Each individual death, experts note, involves a combination of risk factors that can include mental illness, pain, problems accessing care and changes in society at large.

However, starting in 2016, UAB’s Stefan Kertesz, M.D., a professor of medicine, began to see a concerning pattern: Some suicide attempts took place after doctors attempted to reduce prescription of pain medication, including opioids.

The study, titled Clinical contexts of SuicIde following OPIOID transitionS (CSI:OPIOIDS), will reach out to family members of someone who died by suicide and assess whether they would be willing to collaborate in future research.

Kertesz was not the only person who noticed this new disturbing trend.

Meredith Lawrence was with her husband, Jay Lawrence, when he died by a self-inflicted gunshot wound in March 2017, in Tennessee. At that time, he had severe pain and early-onset dementia. Writing in 2017, Meredith described Jay’s doctors’ plan to reduce prescription opioids as the precipitating factor that contributed to his decision to take his own life. When her story made national news, more than 5,000 comments were posted online. By 2019, the Food and Drug Administration issued a warning that rapidly reducing prescription opioids might cause suicide in some people.

But, Kertesz cautions that suicide is not likely to reflect just one factor, such as how quickly a prescription is changed.

“These events are tragic. Several federal agencies have acknowledged a link between suicide and changes in opioid prescriptions, but no really one understands what is happening,” Kertesz said. “We don’t know why some people wind up dead and others don’t, and that’s why research is needed.”

Co-investigator Allyson Varley, Ph.D., with the UAB Center for Addiction and Pain Prevention and Intervention, added that the medical community and society in general can prevent these terrible losses only by understanding the underlying factors of what took place.

“The problem is there is no official agency attempting to capture these events, and that means they are incredibly hard to study,” Varley said.

Lawrence supports their effort.

“I lost my husband in 2017 by suicide after his medications were taken away,” Lawrence said. “At that point, I wrote about our experience for the public, and it drew attention nationally. To see Dr. Kertesz and his colleagues take this seriously matters to me because nobody should lose a loved one over something treatable.”

Working in collaboration with patients, family members and experts from around the country, Kertesz and Varley have designed a national survey to seek family members who have lost someone to suicide after a change in pain medication. Their survey, which takes about 15 to 20 minutes online or by telephone, will assess how the individual reporting on the death is related to the person who died, and what they think happened. Individuals can participate in the survey online, or by calling staff at the Recruitment and Retention Shared Facility in the Division of Preventive Medicine at UAB.

The study is approved by the Institutional Review Board at UAB.

Both Kertesz and Varley are affiliated with UAB’s Department of Medicine, UAB’s Center for Addiction and Pain Prevention and Intervention, and the Birmingham Veterans Affairs Medical Center.

To participate in this study, click here.

(Courtesy of UAB)