Medications for Alcohol and Opioid Use Disorders and Risk of Suicidal Behavior, Accidental Overdoses, and Crime

Am J Psychiatry. 2018 Oct 1;175(10):970-978. doi: 10.1176/appi.ajp.2018.17101112. Epub 2018 Aug 2.


Objective: The authors examined associations between medications for alcohol and opioid use disorders (acamprosate, naltrexone, methadone, and buprenorphine) and suicidal behavior, accidental overdoses, and crime.

Method: In this total population cohort study, 21,281 individuals who received treatment with at least one of the four medications between 2005 and 2013 were identified. Data on medication use and outcomes were collected from Swedish population-based registers. A within-individual design (using stratified Cox proportional hazards regression models) was used to compare rates of suicidal behavior, accidental overdoses, and crime for the same individuals during the period when they were receiving the medication compared with the period when they were not.

Results: No significant associations with any of the primary outcomes were found for acamprosate. For naltrexone, there was a reduction in the hazard ratio for accidental overdoses during periods when individuals received treatment compared with periods when they did not (hazard ratio=0.82, 95% CI=0.70, 0.96). Buprenorphine was associated with reduced arrest rates for all crime categories (i.e., violent, nonviolent, and substance-related) as well as reduction in accidental overdoses (hazard ratio=0.75, 95% CI=0.60, 0.93). For methadone, there were significant reductions in the rate of suicidal behaviors (hazard ratio=0.60, 95% CI=0.40-0.88) as well as reductions in all crime categories. However, there was an increased risk for accidental overdoses among individuals taking methadone (hazard ratio=1.25, 95% CI=1.13, 1.38).

Conclusions: Medications currently used to treat alcohol and opioid use disorders also appear to reduce suicidality and crime during treatment.

Keywords: Alcohol Abuse; Epidemiology; Psychoactive Substance Use Disorder; Suicide; Violence/Aggression.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acamprosate / therapeutic use
  • Adult
  • Aged
  • Alcohol Deterrents / therapeutic use*
  • Alcoholism / drug therapy*
  • Alcoholism / psychology
  • Buprenorphine / therapeutic use
  • Cohort Studies
  • Crime / prevention & control
  • Crime / psychology*
  • Drug Overdose / prevention & control
  • Drug Overdose / psychology*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Methadone / therapeutic use
  • Middle Aged
  • Naltrexone / therapeutic use
  • Opiate Substitution Treatment*
  • Opioid-Related Disorders / drug therapy*
  • Risk Factors
  • Suicidal Ideation*
  • Young Adult


  • Alcohol Deterrents
  • Buprenorphine
  • Naltrexone
  • Acamprosate
  • Methadone