Suicides account for 4% of opioid-related overdose deaths, much lower than previously thought
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Researchers have estimated that only 4% of opioid-related overdose deaths are due to suicide, which contradicts recent estimates that classified 20% to 30% as such, according to findings of a research letter published in JAMA.
“Knowing that the actual percentage and number of suicide deaths among opioid overdose deaths is much lower than previously thought does not relieve clinicians who care for patients with opioid use disorders from evaluating their patient's mental health, but it puts the primary focus of care more squarely on the patient's addiction,” Mark Olfson, MD, MPH, of the department of psychiatry at Columbia University Vagelos College of Physicians and Surgeons, told Healio Psychiatry. “This is also true for the emergency management and evaluation of opioid overdoses. When patients present to emergency departments with nonfatal opioid overdoses, it is important to determine the extent to which the overdose was driven by an opioid addiction or by suicidal intent.”
According to Olfson and colleagues, the upward trends in both suicide deaths and opioid overdoses have directed attention toward defining the extent to which these two public health problems are syndemic. They noted that although prior research has suggested that approximately 25% of opioid overdose deaths are intentional, this research did not evaluate the national distribution of opioid-related deaths by manner. To address this gap, the researchers identified drug overdose deaths involving opioids among individuals aged 15 years and older using mortality multiple cause-of-death data from the National Vital Statistics System. They examined trends from 2000 to 2017 by manner of death using negative binomial regression with population counts as an offset, as well as Wald tests to compare groups and evaluate trends.
Olfson and colleagues found that of 47,506 total opioid deaths, 43,036 were unintentional (90.6%; 95% CI, 90.3-90.9), 1,884 were suicides (4%; 95% CI, 3.8-4.1) and 2,586 were of undetermined intent (5.4%; 95% CI, 5.2-5.7). Those who died by suicide tended to be older, female and white compared with those who died by undetermined intent. Opioid-related deaths per 100,000 people increased from 2.2 to 13.21 for unintentional deaths between 2000 and 2017, and from 0.27 to 0.58 for suicides. Deaths of undetermined intent exhibited no significant trend. During this period, unintentional opioid-related deaths increased from 73.8% to 90.6%, suicides decreased from 9% to 4% and deaths of undetermined intent decreased from 17.2% to 5.4%. The researchers observed significant increases in opioid-related deaths for all racial/ethnic groups, females, males and all age groups, except those aged 35 to 44 years.
“I was surprised that deaths by suicide did not account for a larger share of opioid deaths,” Olfson said. “At the same time, however, it is important to bear in mind that patients who survive opioid overdoses are at increased risk for suicide in the future.” – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Harshal Kirane, MD
Suicide and addiction share a complex relationship. Untreated opioid use disorder leads to progressive deterioration in quality of life and mental health over time, both of which are significant risk factors for suicide. In the midst of the astronomical increase in opioid-related deaths over the past 2 decades, a concurrent increase in suicide rates has been reported, so many have assumed they are correlated. This study looks at a subsection of these deaths.
These results highlight the dramatic rise in lethality of synthetic opioids, causing a spike in unintentional opioid-related deaths. This is most concentrated in young people aged 25 to 44. However, the overall number of opioid-related suicides has remained steady, as many are dying from these hyper-lethal synthetic opioids before they reach the age when intentional suicide — often driven by a deterioration of quality of life due to addiction — occurs (ages 45 to 64).
This study provides important insights on rates of suicide deaths involving opioids, which appear lower than previous reports. This must not diminish the pressing issue of suicide deaths in general among individuals struggling with opioid use disorder.
We must increase access to overdose prevention and addiction treatment or we will continue to see young people die from unintentional overdose. Naloxone training and distribution and medications for opioid use disorder are the most effective ways to prevent death, but a dated stigma too often keeps them from being used. Access to these life-saving treatment options remains woefully limited for many Americans.
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