Although some evidence suggests that the risk of adverse events may increase after the discontinuation of treatment with opioids, data from large national studies are lacking. Researchers sought to determine the likelihood of death from overdose or suicide among Veteran Health Administration patients by examining the association between discontinuation of opioid use and length of treatment.

The evaluation period was from October 2012 to September 2014. Among patients who had an outpatient prescription for an opioid analgesic in fiscal year 2013, approximately 57% had stopped taking opioids. Of the 1,394,089 patients for whom the researchers had complete data, 2,887 died of overdose or suicide.

Stopping opioids was associated with an increased risk of death from overdose or suicide, and this risk was greater the longer patients had been treated. Patients' risk of death from overdose or suicide was higher in the three months after starting or stopping treatment. The incidence of death increased more, however, in the three months after stopping treatment, and these rates didn't stabilize for almost six to 12 months after opioid use was discontinued.

The findings suggest patient-centered efforts to reduce the risk of death from overdose or suicide must go beyond prescription management, according to the authors, who also conclude that patients should be closely monitored for at least three months after treatment is started or stopped. They note that this study was limited in that it didn't take into account the reasons for stopping opioids, and data on adherence to treatment and the use of other drugs were lacking.