{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T02:50:13Z","timestamp":1788922213941,"version":"build-2803163510"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T00:00:00Z","timestamp":1744243200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Importance<\/jats:title>\n                  <jats:p>Centers for Disease Control and Prevention guidelines highlight the increased suicide risk associated with abrupt discontinuations of long-term opioid therapy (LTOT). However, evidence on specific dose and duration \u201cthresholds\u201d of LTOT for suicide risk is limited.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>We aimed to identify opioid dose trajectories before abrupt LTOT discontinuations and their association with 6-month suicide risk.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>This retrospective cohort study analyzed 2016-2021 Florida Medicaid claims for adult non-cancer beneficiaries with abrupt LTOT discontinuation, defined as having a\u2009&amp;gt;\u200915-day gap in opioid supply after \u226590 consecutive days of use. We assessed prescription opioid doses as the mean weekly morphine-milligram equivalent (MME) 6 months preceding the first abrupt LTOT discontinuation. Group-based trajectory modeling identified distinct opioid trajectory patterns, and multivariable Cox proportional hazards models examined associations between trajectory groups and a composite outcome of suicidal ideation, non-fatal suicide attempts, and suicide death 6 months following the abrupt LTOT discontinuation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 15\u2009680 beneficiaries (mean age: 46.2\u2009\u00b1\u200911.1\u2009years; 60.8% female), 4 trajectory groups based on weekly MMEs: Low (&amp;lt;25: n\u2009=\u20098814, 56.2%), moderate (25-50: n\u2009=\u20094313, 27.5%), high (51-150: n\u2009=\u20091452, 9.3%), and very-high (&amp;gt;150: n\u2009=\u20091101, 7.0%) were identified. Compared with the low-dose group, the very-high dose group had a significantly higher risk of suicide-related outcomes [adjusted hazard ratio (aHR): 2.2, 95% confidence interval (95%CI):1.3-3.6], while the moderate and high dose groups had similar risks (moderate: aHR\u2009=\u20091.3, 95%CI: 0.9-1.8, high: aHR\u2009=\u20090.7, 95%CI: 0.4-1.3).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Among Florida Medicaid beneficiaries with LTOT, very-high opioid doses (&amp;gt;150 weekly MME) in the 6 months preceding an abrupt LTOT discontinuation were associated with an increased risk of suicide-related outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/pm\/pnaf044","type":"journal-article","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T15:20:46Z","timestamp":1744298446000},"page":"631-642","source":"Crossref","is-referenced-by-count":6,"title":["Suicide risk after abrupt discontinuation of long-term opioid therapy: an observational cohort study"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2825-9180","authenticated-orcid":false,"given":"Shu","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida , Gainesville, FL 32611,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianze","family":"Jiao","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida , Gainesville, FL 32611,","place":["United States"]},{"name":"Center for Drug Evaluation and Safety (CoDES), University of Florida , Gainesville, FL 32611,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena Jingchuan","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida , Gainesville, FL 32611,","place":["United States"]},{"name":"Center for Drug Evaluation and Safety (CoDES), University of Florida , Gainesville, FL 32611,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill A","family":"Star","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, College of Medicine, University of Florida , Gainesville, FL 32611,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Bian","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Data Science, School of Medicine, Indiana University , Indianapolis, IN 46202,","place":["United States"]},{"name":"Regenstrief Institute , Indianapolis, IN 46202,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debbie L","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida , Gainesville, FL 32611,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0020-8720","authenticated-orcid":false,"given":"Amie J","family":"Goodin","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida , Gainesville, FL 32611,","place":["United States"]},{"name":"Center for Drug Evaluation and Safety (CoDES), University of Florida , Gainesville, FL 32611,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,10]]},"reference":[{"key":"2025100303514217300_pnaf044-B1","volume-title":"Evidence Brief: Benefits and Harms of Long-Term Opioid Dose Reduction or Discontinuation in Patients with 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