In the United States, suicide and opioid misuse share a common, unfortunate characteristic: they are both leading causes of preventable deaths. In 2016, drug overdoses claimed the lives of 64,000 Americans, a total driven by the country’s ongoing opioid crisis. In 2015, more than 44,000 individuals across the country died by suicide.
New research is showing that there are connections between opioid misuse and suicide. Understanding this connection could help communities respond more effectively to people at high risk of suicide and opioid misuse—especially veterans and middle-aged white men—potentially saving lives. Here, EDC’s Chelsey Goddard and Jerry Reed discuss the connection between opioid misuse and suicide.
Q: What do we know about the connection between suicide and opioid misuse?
Reed: Recent research has shown that opioid misuse may be playing a more significant role in suicide than previously acknowledged. The number of suicides attributed to opioid overdose has doubled since 1999, and opioid misuse is associated with suicidal ideation and suicide attempts.
The amelioration of pain lies at the root of both opioid misuse and suicide. People who have survived a suicide attempt will often say that they didn’t want to die—they just wanted their pain to end. I think we’ve seen a similar pattern with the opioid epidemic, where misuse—especially with prescription opioids—is usually a consequence of a person’s inability to find relief from pain.
But ultimately, both opioid misuse and suicide have very real and lethal consequences. Suicide is lethal by definition, and while an opioid overdose may be unintentional, it is often deadly.
Q: Why is it important to understand the relationship between opioid misuse and suicide?
Goddard: Understanding the relationship helps us understand the complexity of both issues. It’s always been incredibly difficult to know if an overdose is a suicide attempt—and for a long time, we didn’t really consider overdoses through the lens of suicide. We just attributed the rising overdose death rates to the increasing potency of the drugs, from prescription narcotics to heroin to synthetic fentanyl, rather than as an intended consequence of use.
But our understanding of opioid overdose as a potential method of suicide is changing how we think about overdoses. In some communities, first responders now consider a person’s third naloxone reversal as a suicide attempt. So the lens of suicide is actually changing how we think about helping people after an overdose. Because often, those of us in opioid misuse prevention ask, “How can people survive the increasing potency of these drugs?” But maybe we should begin asking, “What if they don’t want to survive?”
Q: What steps can communities take to address these twin crises?
Goddard: Communities, hospitals, and prisons all collect data on suicide; they also collect data on opioid overdoses. But until now most states haven’t examined those data sets together. So, a concrete task for public health officials is to better understand the issue of suicide by opioid overdose from the data we already have. Looking at that data can give us a better sense of who is at risk and how we can best intervene. Then we can begin recommending public health solutions.
Reed: Education is essential. This issue is severe enough that we will have to look beyond public health officials for solutions. Community service organizations, faith leaders, first responders, and medical professionals—anybody who works with people at risk—need to know the link between substance misuse and suicide. They need to be able to recognize co-occurring disorders, and they need to know how to link people to services and support. I think we can make a big difference for a lot of people in need if we look at whole community responses to opioid misuse and suicide. But the whole community has to be on board, and the whole community has to know what to do.