Suicides are not driving the US epidemic of opioid overdose deaths, new research suggests.
Overdoses, suicides and deaths by suicide from overdoses have all been on the rise in recent years – as have ‘deaths of despair’ in general.
The parallel increases have drawn speculation that a significant component of the astronomical rate of opioid overdose deaths was a rise in suicides.
Even the Director of the National Institute of Mental Health (NIMH), Dr Joshua Gordon, adopted this line in a September statement.
Columbia University researchers have debunked that notion, however. They found that the proportion of opioid overdose deaths ruled suicides actually fell by more than half between 2000 and 2017.
New Columbia University research debunks US officials prediction that much of the opioid overdose epidemic was fueled by suicides. In fact, the proportion of intentional overdoses fell from nine to four percent between 2000 and 2017 (file)
Paradoxically, the rate of suicide deaths that involved opioids increased, doubling over the same 17 year time frame.
But that’s very little compared to the six-fold increase in deaths from unintentional opioid overdoses.
Between 2000 and 2017, accidental overdose deaths went from accounting for 2.2 out of every 100,000 people’s deaths in the US to 13.2 per 100,000, according to the new study.
‘It’s likely that the increasing use of illicit fentanyl, which is approximately fifty times more potent than heroin, has contributed to the rapid increase in unintentional opioid overdose deaths,’ explained lead author Dr Mark Olfson, a professor of psychiatry at Columbia.
But that wouldn’t explain the link between suicide and opioids.
That relationship is much more complicated.
Suicide, addiction and overdoses all share common risk factors.
For example, people who struggle with addiction and substance misuse are twice as likely to have another mood or anxiety disorder.
And it works the other way around. Roughly half of all people with mental health issues will also develop an addiction at some point in their lives.
Mood and anxiety disorders similarly raise suicide risks.
The research that’s been conducted on these overlapping health issues suggests there are links between them and both experiences as well as genetics and even brain structure.
But it’s a nascent field and scientists are still working to find out with more certainty what the underlying connections are and whether they might be all addressed at once.
Puzzling out whether a death was a suicide or an accident is notoriously difficult.
Previous estimates put the proportion of opioid overdose deaths that were suicides as high as 30 percent.
The Columbia study, published in JAMA, turns that on its head.
Researchers found that, in 2000, suicides accounted for nine percent of overdose deaths.
By 2017, that number had fallen to just four percent.
During the same period of time, drug overdose deaths on the whole quadrupled.
So the trends, in fact, ran in opposite directions.
‘Our findings suggest that the current emphasis on the contribution of suicide to opioid-related deaths may be overstated and that for most individuals who overdose on opioids, the primary clinical focus should be on substance use,’ said Dr Olfson.
However, he and his team note that an opioid overdose – intentional or not – is a risk factor for suicide itself.
They say that more research needs to be done to parse out just how opioids figure in to suicides and suicide attempts.
‘Considering the high risk of suicide after nonfatal opioid overdose, this information could be especially valuable in suicide prevention efforts,’ said Dr Olfson.
- For confidential help, call the National Suicide Prevention Lifeline at 1-800-273-8255 or click here
- For confidential support on suicide matters in the UK, call the Samaritans on 08457 90 90 90, visit a local Samaritans branch or click here
- For confidential support in Australia, please call Lifeline on 13 11 14 or click here