Opioid Use and Misuse and Suicidal Ideation Among Persons With Spinal Cord Injury: Differential Risk for Former Service Members and Non-Service Members.

INTRODUCTION: People with spinal cord injury (SCI) have an elevated risk of secondary health conditions, including pain, which is often treated with prescription opioids, depression, and suicide. Our purpose was to compare opioid use and misuse between Former Service Members (FSMs) and non-FSMs with SCI, identify risk factors, and assess the differential relationships of opioid use and misuse with suicide ideation (SI). MATERIALS AND METHODS: Data were collected from 1,253 participants with SCI. Using logistic regression, risk factors for SI were evaluated, including interactions between FSM status, opioid misuse, and multiple opioid prescriptions. SI was measured using the patient health questionnaire-9. RESULTS: SI was reported by 9% of FSMs and 13% of non-FSMs. It was related to self-reported misuse of opioids among non-FSMs, intermittent use of 2 or more prescription opioids among FSMs, and 3 or more prescription opioids for both FSMs and non-FSMs. Risk of SI was also associated with more painful days, probable major depression (PMD), and more severe SCI. Non-FSMs who reported misusing their prescription opioids had 4.01 (95% CI = 2.14, 7.52) greater odds of SI, while FSMs did not have greater odds of SI. However, FSMs prescribed 2 or more opioids had 3.91 (95% CI 1.27, 12.08) greater odds of SI, while non-FSMs did not have a statistically significant effect. Both FSMs OR = 10.30 (95% CI 2.42, 43.97) and non-FSMs OR = 2.52 (95% CI 1.12, 5.70) receiving 3 or more prescription opioids had greater odds of SI, with FSMs having over 3 times the odds of non-FSMs. CONCLUSION: FSMs appear to have a particularly greater risk of SI when using two or more types of opioids, despite no relationship between self-reported misuse and SI. Closely monitoring prescription opioids is essential for minimizing SI and the risk of suicide among FSMs and non-FSMs with SCI.