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Heroin Addiction and Related Clinical Problems: 2018, 20, N2 (pages: 35 - 40)

Excess Suicide Mortality in Heroin Use Disorder Patients Seeking Opioid Agonist Treatment in Slovenia and Risk Factors for Suicide

Lovrecic M., Lovrecic B., Maremmani I., and Maremmani A.G.I.

Summary: Background: Heroin Use Disorder (HUD) patients are more endangered by suicide than the general population. Excess suicide mortality and the risk factor for suicide in HUD patients seeking Opioid Agonist Treatment (OAT) in Slovenia were both assessed. Methods: Record-linkage study of a well-defined cohort of 3,949 HUD patients seeking OAT in Slovenia in the period from 1st January 2004 to 31st December 2006, and General Mortality Register for ascertained vital status in cohort till 31st December 2011. Results: In the 2004-2011 period there were 31 suicides among 3,949 HUD patients seeking OAT. Standardized mortality ratio (SMR) for suicide in HUD patients was 4 (95% CI: 2.8-5.6) times higher than that of the general Slovenian population of the same age over the same period of time. SMR for male HUD patients was 3.7 (95% CI 2.6-5.4) times higher than that of Slovenian males of same age and 2.2 times higher than that of females. SMR for female HUD patients was 7 (95% CI: 2.6-18.7) times higher than that of Slovenian females of the same age. Higher age at cohort treatment entry is an important risk factor for suicide; hazard risk for suicide was significantly higher in patients entering the cohort when older (HR=1.08, 95% CI: 1.02-1.13, p=0.003), whereas those at their first OAT episode seem to be protected from suicide (HR=0.139, 95% CI: 0.019-1.036, p=0.054), while male gender, unemployment and a living alone status do not constitute a statistically significant risk factor for suicide in HUD patients seeking OAT. Conclusions: Specific suicide prevention interventions tailored to the needs of HUD patients are required.