Psychiatric Comorbidities and Risks of Death, Non-Fatal Overdose, and Self-Harm in Opioid Agonist Therapy: A Retrospective Cohort Study
In brief
Other substance use disorders more than doubled overdose and self-harm odds during opioid therapy
In a Finnish registry study of 1,235 people receiving opioid agonist therapy, other substance use disorders were associated with more than twice the odds of nonfatal overdose and self-harm; psychosis was also linked to higher odds of both. Alcohol use disorder was associated with higher risk of death. These retrospective findings support screening, but do not show that the disorders caused the outcomes.
- Journal
- European addiction research (Q1)
- Published
- 19 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Yangyang Li, Alexander Denissoff, Margareeta Häkkinen, Lauri H Sillanmäki, Solja Niemelä
- PMID
- 42895930
- DOI
- 10.1159/ear/acrag001
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (paper of the day, 22 October 2026): Cohort linking psychiatric comorbidities to overdose and self-harm
Abstract
INTRODUCTION: Psychiatric disorders are common among patients with opioid use disorder (OUD). Opioid agonist therapy (OAT) is an effective treatment for OUD, but outcomes for patients with psychiatric comorbidities remain understudied. This study aimed to examine the connections between psychiatric comorbidities and outcomes in individuals undergoing OAT. METHODS: We retrospectively collected data from the Wellbeing Services County of Southwest Finland clinical registry. The cohort included 1235 patients receiving OAT from January 1, 2004, to April 15, 2021. Patients attending OAT, psychiatric diagnoses, overdoses, and self-harm were identified from the registry data using ICD-10 codes. In cases of death, the register also included the date of death. We analyzed associations between psychiatric comorbidities and outcomes using Cox regression for death and logistic regression for non-fatal overdose and self-harm. RESULTS: We identified the prevalence of the following psychiatric comorbidities: non-substance use disorder (non-SUD) psychiatric disorders (39.0%), psychosis (17.0%), mood disorders (29.1%), anxiety disorders (26.2%), personality disorders (20.7%), and other SUDs not related to opioids (other SUDs) (61.4%). After adjusting for all covariates, we found an association between alcohol use disorder (AUD) (hazard ratio = 1.54, 95% confidence interval [CI] = 1.06-2.22) and a higher risk of death during OAT. Additionally, non-SUD psychiatric disorders (overdose: odds ratio [OR] = 1.64, 1.14-2.36; self-harm: OR = 1.50, 1.03-2.18), psychosis (overdose: OR = 1.89, 1.29-2.79; self-harm: OR = 1.87, 1.26-2.78), and other SUDs (overdose: OR = 2.61, 1.81-3.83; self-harm: OR = 2.56, 1.74-3.82) were associated with higher odds of both overdose and self-harm. CONCLUSION: The study emphasizes the need for screening and secondary preventive measures for psychosis and other SUDs (particularly AUD) in OAT settings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.