Study sheds light on relationship between opioids and suicidal ideation in SCI survivors

Opioid misuse, not prescribed opioid use alone, is linked to suicidal ideation in spinal cord injury survivors, a study has found.

The research examined the complex relationship between opioids and suicidal ideation in people living with spinal cord injury.

Spinal cord injury, or SCI, can affect movement, sensation and bodily functions, and many survivors live with long-term pain.

For the roughly 300,000 Americans living with SCI, chronic pain is often part of daily life and opioids are prescribed for many.

Depression is also common among people with spinal cord injury, with their risk three times higher than that of the general population.

The study was led by James S Krause, distinguished university professor and associate dean for research in the College of Health Professions, and Clara E Dismuke-Greer, a research health scientist with the Palo Alto VA Health Care System in California.

The team examined the relationship between prescription opioid use, opioid misuse and suicidal ideation, which means thoughts about taking one’s own life.

Researchers said the findings reveal patterns of opioid use that could act as warning signs for increased suicide risk and give clinicians and caregivers new chances for intervention and prevention.

Opioids are strong pain-relieving drugs that have been at the centre of debate because of their broad use and high potential for addiction and overdose.

For people living with daily pain, opioids can provide significant relief by blocking pain messages reaching the brain and releasing dopamine, a brain chemical linked to reward and pleasure.

For physicians, particularly those who do not specialise in treating SCI or are less familiar with alternative approaches, these drugs can become the first line of defence when a patient has chronic, unmanaged pain.

Krause and Dismuke-Greer’s study also noted the emotional toll that living with SCI can have on patients.

Krause, who has lived with SCI for 54 years, said: “It takes great vigilance to survive day to day with a serious spinal cord injury.

“Even a single misstep can result in pressure ulcers and start a cycle of after-effects that unfold.”

Pressure ulcers are wounds caused by prolonged pressure on the skin, often affecting people with limited mobility.

Researchers said the physical impairments and secondary mental and emotional conditions experienced by people with SCI mean they are more likely to show symptoms of depression and substance misuse.

Substance misuse means taking a medication in a way other than originally prescribed.

Despite wider observations about depression, opioid misuse and possible suicidal ideation in spinal cord injury survivors, researchers said the formal relationship had been understudied.

Krause said: “The work we’re doing with opioids and SCI is pretty unique.

“There’s not much literature.

“Unlike in a lot of other fields, when you deal with spinal cord injury, there’s still a lot of room for breaking new ground.”

Between September 2021 and December 2023, the team surveyed more than 1,200 people with spinal cord injuries to better understand their experiences with opioids and depression in daily life.

Participants were asked whether they used opioids, which medicines they used, how often they took them and whether they were used in combination with others.

The study found that simply taking prescribed opioids was not statistically associated with suicidal ideation.

Instead, elevated risk was seen when people misused opioids or took three or more opioids at the same time.

This is known as polyopioid use.

Depression and experiencing 15 or more painful days a month were also strong predictors of suicidal ideation in the SCI population.

Researchers said healthcare providers treating people with SCI should be on high alert for suicidal ideation when patients are prescribed multiple opioids, show signs of misuse or report persistent severe pain.

Dismuke-Greer said: “Polyopioid use should be a flashing light for providers to screen for suicidal ideation.”

The team said caregivers and family members could also benefit from greater awareness of multiple opioid prescriptions, signs of misuse and behavioural changes.

They said this could help loved ones advocate for mental health screening and intervention.

The researchers are now focusing on protective factors that may reduce suicidal ideation, including job opportunity satisfaction and social engagement.

Krause said the wider goal is to understand what helps people with SCI thrive.

He said: “People have a good bit of control.

“They have to be responsible for their own lives, and this gives them some information.

“If we understand what predicts something, we have the opportunity to change it.”