Opiates demonstrate increased presence in suicide completion

NEW YORK — The percentage of suicide decedents who had opiates in their blood nearly doubled from 2006 to 2017, according to data presented in a press briefing at the American Psychiatric Association Annual Meeting.

“Other studies have looked at the rates of opioid use and suicide incidence. They mostly use death certificate data because there’s an uneven set of data sources – different coroners and death examiners have different standards,” Paul Nestadt, MD, fellow at the Johns Hopkins Bloomberg School of Public Health, who presented the results on behalf of his student, Daniel Borota, said during his presentation. “In Maryland, we have the first statewide medical examiner system for all unnatural deaths ... which gives us data that’s unique. We looked at the relationship between opioid use in these decedents and suicide completion.”

Using medical examiner system data — which included full toxicology reports on all suicides and unexplained deaths — Nestadt and colleagues examined opiate prevalence in nearly 5,900 suicides in Maryland between 2006 and 2017. They also controlled for age, sex, race and demographics. In total, 750 decedents tested positive for opiates.

According to Nestadt, the proportion of suicide decedents taking opiates almost doubled from 2006 (8.8%) to 2017 (17.7%) in Maryland (adjusted OR = 1.92, 95% CI, 1.49-2.47; P < .0001), whereas the presence of cocaine dropped slightly, and alcohol remained the same. He also noted that this increase was primarily in the last 4 or 5 years. This increase included opiate overdose suicides (adjusted OR = 2.19; P < .0001); however, removing these deaths left a steeper increase. Notably, the trend was greatest in African American decedents, whose opiate rates increased more than 5-fold between 2006 to 2017.

“The results suggest that opiates are not only increasing addiction as a cause of accidental overdose, but are also demonstrating an increased presence in suicide completion across the board, even outside of opiate overdoses,” Nestadt said. “We should be looking out more among our opiate users to evaluate the suicide risk and among our depressed patients to be particularly vigilant about opioid use, not just in terms of addiction, but use in general.” – by Savannah Demko

Reference:

Borota, D. P1-216. Presented at: American Psychiatric Association Annual Meeting; May 5-9, 20178; New York.

Disclosures: Nestadt reports royalties from Johns Hopkins POCIT guide.