{"doi":"10.1093/aje/kwae394","title":"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","abstract":"We examined the association between rapid reduction or discontinuation of opioid therapy and self-harm, suicide attempt, and suicide death among patients receiving high-dose, long-term opioid therapy (HD-LTOT) and examined effect measure modification by individual and neighborhood-level characteristics. Using private insurance data from North Carolina, this retrospective cohort study covered January 2006 to September 2018, with up to 4 years of follow-up. Participants included patients aged 18-64 years who were prescribed HD-LTOT. The time-varying exposure was ever exposed to rapid opioid therapy reduction or discontinuation vs never exposed. The outcomes were self-harm or suicide attempt, suicide death, and the combined outcome. We estimated cumulative incidence and used Fine-Gray models to estimate sub-distribution hazard ratios (HRs). There were 21 450 patients prescribed HD-LTOT. In year 1, rapid opioid therapy reduction or discontinuation was not associated with the combined outcome (HR = 1.09; 95% CI, 0.61-1.96). However, in years 2-4, rapid opioid therapy reduction or discontinuation was associated with higher hazard of the combined outcome (HR = 2.77; 95% CI, 1.45-5.27). This association was stronger among patients with mental health conditions and those residing in underserved neighborhoods. These findings underscore the importance of provider training in adhering to guideline-concordant gradual tapering, offering mental health support, and ensuring patient safety throughout the tapering process.","journal":"American Journal of Epidemiology","year":2024,"id":466522,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9485,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":944265,"name":"Bethany L. DiPrete","orcid":"0000-0003-1298-4433","position":1,"is_corresponding":false},{"id":6027,"name":"Brian W. Pence","orcid":"0000-0001-7321-9538","position":2,"is_corresponding":false},{"id":797054,"name":"Arrianna Marie Planey","orcid":"0000-0003-4739-090X","position":3,"is_corresponding":false},{"id":338712,"name":"Stephen W. Marshall","orcid":"0000-0002-2664-9233","position":4,"is_corresponding":false},{"id":1299110,"name":"Naoko Fulcher","orcid":null,"position":5,"is_corresponding":false},{"id":597588,"name":"Shabbar I. Ranapurwala","orcid":"0000-0002-3944-3912","position":6,"is_corresponding":false},{"id":817984,"name":"Ishrat Z Alam","orcid":"0000-0002-9173-571X","position":0,"is_corresponding":true}],"reference_count":56,"raw_metadata":null,"created_at":"2026-07-19T02:05:06.743102Z","pmid":"39380140","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}