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Relationship of prescription and nonprescription opioid use, opioid misuse, and alcohol use with suicidal ideation among people with spinal cord injury

Spinal Cord (2026)Cite this article

Subjects

Abstract

Study design

Cross-sectional study.

Objective

To identify the relationship of prescription opioid use, self-reported misuse of opioids, and binge drinking days with suicidal ideation (SI) in a cohort of participants with spinal cord injury (SCI).

Setting

Medical university in the southeastern United States.

Methods

This was a cross-sectional analysis of self-report data from 1253 study participants with SCI, all of whom were enrolled in a longitudinal study of health outcomes. SI was assessed and dichotomized using item 9 on the Patient Health Questionnaire-9.

Results

Occasional use of 3 or more prescription opioids was associated with greater odds of SI (OR = 3.53, CI = 1.50–8.31), as was self-reported misuse of prescription opioids (OR = 3.51, CI = 1.83–6.72). Days of binge drinking was unrelated to SI. Odds of SI were higher for those with depression (OR = 5.98, CI = 3.60–9.92) and those who reported 15 or more painful days in a month (OR = 2.15, CI = 1.24–3.73). Compared with the most severe SCI (high cervical, non-ambulatory), participants who were ambulatory (OR = 0.36, CI = 0.15-0.86) or were non-cervical/non-ambulatory (OR = 0.32, CI = 0.14-0.75) reported lower odds of SI.

Conclusions

Prescription opioid use needs to be closely monitored by healthcare professionals for those who use multiple opioids and who self-report misusing opioids, as there is a relationship with SI, even when considering multiple covariates pain and depression.

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Data availability

The data set is not currently publicly available and has not been sufficiently de-identified. It will be made publicly available at the end grant cycle, consistent with federal regulations.

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Funding

The contents of this publication were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DPHF0009). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this publication do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.

Author information

Authors and Affiliations

  1. College of Health Professions, Medical University of South Carolina, Charleston, SC, USA

    James S. Krause, Devyn E. Smith & Nicole D. Dipiro

  2. Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA

    Clara E. Dismuke-Greer

Authors
  1. James S. Krause
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  2. Clara E. Dismuke-Greer
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  3. Devyn E. Smith
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  4. Nicole D. Dipiro
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Contributions

JK was the principal investigator who developed the purpose and overall design and who contributed to the development of the methods, discussion and conclusion sections. CDG was responsible for conducting the analyses and writeup of the statistical methods. DS developed the introduction and parts of the discussion and contributed to the development of the results. ND contributed to the literature review, as well as linking the current findings to the literature.

Corresponding author

Correspondence to James S. Krause.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval and consent to participate

We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research. This study was approved by the Institutional Review Board (IRB) of the Medical University of South Carolina (Pro00104259). Informed consent was obtained from all participants, with a waiver of written informed consent approved by the IRB.

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Krause, J.S., Dismuke-Greer, C.E., Smith, D.E. et al. Relationship of prescription and nonprescription opioid use, opioid misuse, and alcohol use with suicidal ideation among people with spinal cord injury. Spinal Cord (2026). https://doi.org/10.1038/s41393-026-01192-3

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