Alcohol, Opioid Addiction Meds Reduce Crime, Suicidality

Medications currently used to treat alcohol and opioid use disorders also appear to reduce suicidality and crime, results from a large population-based study suggest.

"While it has been established that these medications are effective in reducing alcohol and opioid use, this is the first time that real-world improvements in these key health and social outcomes have been demonstrated," lead author Seena Fazel, MD, Department of Psychiatry, University of Oxford, United Kingdom, said in a statement.

"The findings support the appropriate prescription of opioid medications as an important strategy to reduce adverse outcomes related to opioid use disorder, particularly for suicidality, crime, and violent crime," Fazel told Medscape Medical News.

The study was published online August 2 in the American Journal of Psychiatry.

Reduction in Suicidal Behavior

The researchers analyzed data for more than 21,000 people who received treatment with at least one of four medications used to treat alcohol and opioid use disorders. These included acamprosate (Campral, Forest Laboratories), naltrexone (multiple brands), methadone (multiple brands), and buprenorphine (multiple brands).

They compared rates of suicidal behavior, accidental overdose, and crime for the same individuals during the period when they were receiving one of these medications with rates during the period when they were not.

No significant associations with any of the primary outcomes were found for acamprosate.

For naltrexone, there was a reduction in accidental overdose during the period while on treatment compared to the period while off treatment (hazard ratio [HR], 0.82, 95% confidence interval [CI], 0.70 - 0.96).

With buprenorphine treatment, significant reductions were found for overall arrest rates (HR, 0.77; 95% CI, 0.72 to 0.84) as well as for arrests for violent crime (HR, 0.65; 95% CI, 0.50 to 0.84) and accidental overdose (HR, 0.75; 95% CI, 0.60 to 0.93).

For methadone, there was a significant 40% reduction in suicidal behaviors (HR, 0.60; 95% CI, 0.40 - 0.88) during treatment, as well as significant reductions in overall arrest rates (HR, 0.87; 95% CI, 0.83 - 0.91) and arrest rates for violent crime (HR, 0.84; 95% CI, 0.73 - 0.96). However, methadone treatment increased the risk for accidental overdose (HR, 1.25; 95% CI, 1.13 - 1.38).

"Among individuals at high risk of accidental overdose, buprenorphine could be considered as a first-line treatment," Fazel said.

Results Meaningful, Not Surprising

Commenting on the results for Medscape Medical News, Harshal Kirane, MD, director of addiction services, Staten Island University Hospital, New York City, said, "These results are not surprising but are incredibly meaningful and validate and reinforce some other observations.

"Alcohol and drugs generally have really devastating impacts on people's lives, which include deterioration in social functioning, which can translate into deterioration in mental health, which in extremes can lead to suicide attempts and suicidality or criminality," said Kirane.

"The idea that taking medication for drug and alcohol abuse, imbedded with other treatment services, may lead to a diminishment of those end-stage manifestations of addiction is very reassuring and highlights the value of trying to engage as many people as possible in medication-assisted treatment," he added.

"It's important to note," said Kirane, "that this study was done in Sweden, and there are some aspects of substance abuse care that are quite different than in the US. Most notably, the level of engagement of Americans in addiction care is woefully low. Only about 10% to 15% at best of Americans who need care access any form of substance abuse care, whereas in Sweden, it's about 70%."

The study was supported by the Wellcome Trust, the Swedish Research Council, and the Karolinska Institutet. Dr Fazel and Dr Kirane have disclsoed no relevant financial relationships.

Am J Psychiatry. Published online August 2, 2018. Abstract

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