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Opioids largely fuel increase in deaths by suicide, overdose in US
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Between 2000 and 2017, the age-adjusted rate of deaths from suicide and unintentional overdose have more than doubled in the United States, largely fueled by opioid use, according to a review published in New England Journal of Medicine.
The combined number of deaths from suicide and unintentional overdose rose from 41,364 in 2000 to 110,749 in 2017 in the United States, Amy S.B. Bohnert, PhD, and Mark A. Ilgen, PhD, from the department of psychiatry, University of Michigan, and the VA Center for Clinical Management Research, wrote. Overall, more than 40% of these deaths in 2017 involved opioids, though it is likely unrecorded opioids contributed to many more deaths.
“Overdose and suicide are unique among common causes of death in the United States in that they are both increasing, while everything else is decreasing,” Bohnert told Healio Psychiatry. “These problems have been considered as separate issues when it comes to research, treatment and policy response, but in fact they share many of the same causes.”
In their review, Bohnert and Ilgen described the links between suicide, overdoses and opioid use, as well as prevention strategies and unresolved issues.
The researchers highlighted two theories to explain how opioid use has contributed to large increases in the rates of death by overdose and suicide over the last 20 years. The first theory states there is an increasing “demand” for opioids, meaning that more people — particularly the working-class people — turn to opioids to cope with lacking socioeconomic opportunities. The second theory states there is an increasing “supply” of opioids, meaning the number of people with opioid use disorders rose as opioids became more available in the U.S. due to increased prescribing and rises in illegal substance use.
Prior research has found that several causes and risk factors, beyond opioid use, are related to suicide and overdose, Bohnert and Ilgen wrote.
“Age-adjusted mortality rates in 2017 for both suicide and unintentional overdose in the United States were approximately twice as high among men as among women,” they explained in their paper. “In addition, death rates for both were highest in 2017 among people who identified as white or Native American and lowest among people who identified as black or Asian. Rates were also highest during midlife (41 to 64 years of age) and lowest among older persons ( 65 years of age).”
In addition, mental health conditions have been linked to an increased risk for suicide and unintentional overdose, both from illicit drugs and medication-related reasons.
Based on these shared factors, Bohnert and Ilgen recommended some potential prevention interventions, including more programs to improve the quality of pain care, expanding access to psychotherapy and increasing access to medication-assisted treatment for opioid use disorders.
“Clinicians should be aware that chronic pain increases risk for suicide, above and beyond the contribution of other psychiatric conditions that may be present,” Ilgen told Healio Psychiatry.
“Clinicians should ask their patients with chronic pain about their thoughts of suicide and engage in a discussion of the patient’s perceptions of the role that opioids might play in any suicidal thoughts or plans,” he said. “For those patients with significant suicidal ideation, the goal should be to help increase hope about the ability to cope with pain while simultaneously working to increase safety and address psychiatric symptoms.” – by Savannah Demko
Disclosures: Ilgen reports serving as cofounder of and owning shares in Arborsense. Bohnert reports no relevant financial disclosures.