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Opioid Use Disorders and Suicide: A Hidden Tragedy (Guest Blog)

April 20, 2017

At a Congressional briefing on April 6, the President of the American Psychiatric Association, Dr. Maria Oquendo, presented startling data about the opioid overdose epidemic and the role suicide is playing in many of these deaths. I invited her to write a blog on this important topic. More research needs to be done on this hidden aspect of the crisis, including whether there may be a link between pain and suicide. —Nora
Oxycodone pills spilling out of a bottle

In 2015, over 33,000 Americans died from opioids—either prescription drugs or heroin or, in many cases, more powerful synthetic opioids like fentanyl. Hidden behind the terrible epidemic of opioid overdose deaths looms the fact that many of these deaths are far from accidental. They are suicides.

Let me share with you some chilling data from three recent studies that have investigated the issue.

In a study of nearly 5 million veterans recently published in Addiction, scientists reported that presence of a diagnosis of any substance use disorder and specifically diagnoses of opioid use disorders (OUD) led to increased risk of suicide for both males and females.  The risk for suicide death was over 2-fold for men with OUD.  For women, it was more than 8-fold.  Interestingly, when the researchers controlled the statistical analyses for other factors, including comorbid psychiatric diagnoses, greater suicide risk for females with opioid use disorder remained quite elevated, still more than two times greater than that for unaffected women.  For men, it was 30 percent greater.  The researchers also calculated that the suicide rate among those with OUD was 86.9/100,000.  Compare that with already alarming rate of 14/100,000 in the general US population.

You may be tempted to think that these shocking findings about the effects of OUD on suicide risk are true for this very special population.  But that turns out not to be the case. 

Another US study, published last month in the Journal of Psychiatric Research, focused on 41,053 participants from the 2014 National Survey of Drug Use and Health.  This survey uses a sample specifically designed to be representative of the entire US population.  After controlling for overall health and psychiatric conditions, the researchers found that prescription opioid misuse was associated with anywhere between a 40 and 60 percent increased risk for suicidal ideation (thoughts of suicide).  Those reporting at least weekly opioid misuse were at much greater risk for suicide planning and attempts than those who used less often.  They were about 75 percent more likely to make plans for a suicide and made suicide attempts at a rate 200 percent greater than those unaffected.

Using a different strategy, a review of the literature in the journal Drug and Alcohol Dependence estimated standardized mortality ratios for suicide.  This is a way of comparing the risk of death in individuals with a given condition compared to individuals from the general population.  The researchers found that for people with OUD, the standardized mortality ratio was 1,351 and for injection drug use it was 1,373.  This means that compared to the general population, OUD and injection drug use are both associated with a more than 13-fold increased risk for suicide death.

These are stunning numbers and should be a strong call to action.

Persons who suffer from OUD are highly stigmatized. They often talk about their experience that others view them as “not deserving” treatment or “not deserving” to be rescued if they overdose because they are perceived as a scourge on society.  The devastating impact of this brain disorder needs to be addressed.  People who could be productive members of society and contribute to their families, their communities, and the general economy deserve treatment and attention. 

As a country, we desperately need to overcome stigmatizing attitudes and confront the problem. We need to understand what causes some individuals to become addicted when exposed to opioids and thus study the biological basis of the disease of opioid addiction. We desperately need to know what the best treatments are for a given individual, and for that too, we need research to identify biomarkers for treatment response. And given the fact that effective medications exist but are drastically underutilized, we need to overcome institutional and attitudinal barriers to these treatments and deliver them to the 24 million people who could benefit. It can prevent not only the suffering of addiction and the danger of unintentional overdose but also help prevent the tragic outcome of opioid-related suicide.

This page was last updated April 2017

Comments

Opiate Use and Suicide

Thank you for a very thorough and compassionate article. I live to see the day when addicts will be treated like kidney, liver, heart and lung patients. Then one can hope such civility will be extended towards those with mental illness.

Applause

I admit it. A lot of my horror and reaction is personal.
My paternal grandfather drank himself to death. One of my father's brothers drank himself to death. Another brother died in a murder suicide pact with his wife.
My mother killed herself when I was a child.
I just learned that my sister killed herself last month.
And that's just the family history I know about.
"Straight" people do not want to hear about suicide. Persons with substance issues conclude their fate is in the hands of their addiction and faceless forces they cannot control.
The true value of this article is direct assertions bulwarked by facts, facts and more facts.
As a society we must listen.
When is that going to happen?
Great work Dr. Oquendo.
Thank you!!!!

Opiods suicide

My sister unfortunately committed suicide by using opiates. I was the last to talk with her and the first to find her. And it's still as vivid as that day some fifteen years later. My sister was only 38 yrs old, the single, devoted mother of an eight year old boy. We thought she was happy, she was just a month shy from graduating with her degree. She had worked so hard, she was motivated, planning for a future, we thought.
If only we had known. If only we could've had the chance to stop her. I'd do anything to take back that day. Forever wondering if I could have done anything to change what happened to make my only sibling take her life, to leave a family that loved her, a young son who needed her.
Suicide changes families in too many ways to count, most of them are far from positive. My family has never been the same, and probably never will.
My advice, what I wish I had known, is to periodically check in with your loved ones. Especially after life changes, or challenging times. It never hurts to ask if someone if they are doing alright. Really alright.
And if you know someone - or are someone - who thinks about harming yourself, please reach out. There are people that care.

Listen, the key sentence in this post,

Yea, people commit suicide. Dopers more than non dopers. It's not because of being "stigmatized".
It's because EVERYTHING that meant ANYTHING to them is now gone, by their own hand at that!

KEY SENTENCE: given the fact that effective medications exist but are drastically underutilized, we need to overcome institutional and attitudinal barriers to these treatments...

Let me remind you, people, that THIS IS A GOVERNMENT WEBSITE.

The VERY SAME GOVERNMENT that has placed the barriers between addicts and buprenorphine!

The VERY SAME GOVERNMENT that is ONLY NOW realizing that sending addicts home IN FULL WITHDRAWAL is only going to lead them back to the hospital later the same day DEAD, AGAIN, only to be revived again and sent home in withdrawal again, and again, and again, while the buprenorphine sits on the shelf, unused.
These BARRIERS have caused how many deaths?

SUICIDE CAN NOT COMPETE WITH THE DAMAGE DONE BY THE INEPTITUTE OF DECISION MAKERS IN OUR COUNTRY!

Knee jerk reaction by the DEA, making it more difficult for people in pain to get their meds, has preceded the sudden spike in fentanyl deaths.

When the DEA found out that dopers were using a harmless tea called Kratom to help ease the suffering of opioid withdrawal THEY TRIED TO BAN IT. In the middle of an "opioid epidemic".

Yea, if suicide is "tragic", then what do you call "putting barriers between addicts and the meds that can save their lives"?
REPREHENSIBLE? MURDEROUS? Or just plain STUPID?

politics and addiction

I agree with Rich , Government is only now learning that treatment works, and most cannot stop an powerful brain- drug action with a "just say no" approach. Just learned that Trump has fired Dr. Murthy who astutely and with great precision pointed out the nature of and the depth of our Countries addictions... So more bad government on the way, voters who have not lost a child or loved one to addiction, need to become educated about the need for access to treatment, and medication assisted treatment, not more "drug wars" Sadly Trump is going in opposite direction towards more drug wars, and less treatment...God help us all...

Opioids

I clearly remember in late 1980's being asked repeatedly what my pain level was after a c-section. Pain was the 5th vital sign. I then remember the ease at which our trusted medical community was prescribing opioids to young people including women in their reproductive years and not just a 3 -5 day supply but sometimes 90 day supply. Then people became addicted. Some of the very people who prescribed the medication instead of helping them no longer wanted to see them. In their defense they weren't educated in treating addiction although they should be. We will always be at risk as long as money and medicine are so closely tied together. This is the most devastating crisis I have ever seen in my life. No one wakes up and says "today I think I want to be an addict." Read the book "Dream Land" by Sam Quinones. The book explains how this epidemic was like the perfect storm.

All too real

Thank you so much for this! I've been marching on the front lines of this epidemic since I lost my daughter in 2015. She was 26 years old and was prescribed copious amounts of opiates for a chronic health condition. The fact that she "needed them", did not exclude her from becoming addicted over the course of 3 years. My daughter's death was ruled a suicide, is being investigated as a homicide, but is absolutely the result of her addiction; so it is important that these deaths are considered when we show the numbers. Watching her life change from a talented athlete and bright college student to a person living day to day dependent on pills and patches was nearly as hard as losing her.

Suicide and opiate addiction

Thank you so much for talking about this. It has gotten so little attention. My son suffered from depression and addiction to opiates in the last 5 months of his life. He died by suicide. It was then I found out how common it was among those in recovery. No official study, they just told me. I write about it all the time on my blog and I am working with one of your NIMH staff, Dr. Horowitz on the ASQ suicide screening.

My son

My 24-year-old son died of a heroin overdose in November, 2014. The week before he died he talked of suicide. He had been in rehab and was clean 19 days before he took that lethal dose. He knew the dangers of using again. After his death I was able to read old emails and found he was talking of suicide 2.5 years before his death, during his Oxycontin addiction. I was clueless and had no idea.

Thank you very much for

Thank you very much for sharing this story, so that others might be made aware of this possibility in loved ones who may have an opioid addiction.

Find Help Near You

The following website can help you find substance abuse or other mental health services in your area: www.samhsa.gov/Treatment. If you are in an emergency situation, people at this toll-free, 24-hour hotline can help you get through this difficult time: 1-800-273-TALK. Or click on: www.suicidepreventionlifeline.orgExternal link, please review our disclaimer.. We also have step by step guides on what to do to help yourself, a friend or a family member on our Treatment page.

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    Dr. Nora Volkow: Video Highlights

    NIDA Director, Dr. Nora D. Volkow Videos

    • National Committee for Quality Assurance (NCQA): Quality Talks, October 2016
      Treating Addiction Within the Health Care System
    • APA TV, May 2016
      APA TV chats with Dr. Nora Volkow, the Director of NIDA to hear about her lecture on drug abuse and the opioid epidemic.
    • Kentucky Educational Television, May 2016
      One to One with Bill Goodman: Dr. Nora Volkow
    • TEDMED, January 2015
      Why do our brains get addicted?
    • The World Science Festival, May 2013
      Meet Pioneer in Science, Dr. Nora Volkow
    • Rockburn Presents, November 2012
      Dr. Nora Volkow
    • Brookhaven National Laboratory WBNL Video, October 2012
      Chemistry celebration: FDG: Contribution to Our Understanding of Addiction
    • CBS 60 Minutes, April 2012
      Hooked: Why Bad Habits Are Hard to Break 
    • Science Times, June 2011
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