Suicide and opioids

There is a distinction between intentional suicide by drug overdose and unintentional, accidental overdose deaths.

Interventions to prevent overdose deaths in suicidal people will differ from interventions targeted as accidental overdoses.

Strategies for reducing opioid-overdose deaths do not include screening for suicide risk, nor do they address the need to tailor interventions for suicidal persons.

There is inaccuracy of data on the proportion of suicides among opioid-overdose deaths, which are frequently classified as undetermined if there is no documented history of depression or a suicide note.

In 2016, the CDC reported 42,000 opioid-overdose fatalities, including an unknown number of suicides.

In 2017 there was an estimated number of deaths among Americans from suicide and unintentional overdose of 110,749.

More than 40% of suicide and overdose deaths in 2017 were known to involve opioids.

There is a direct relationship of opioid usage and links to suicide risk.

Opioid use disorders have a distinctly strong relationship with suicide as compared with other substance use disorders.

Pain causes alterations in the neurocircuitry related to reward, which results in vulnerability to suicide and potentially to riskier use of opioids

The two populations that are more likely to receive opioid prescriptions are patients with chronic pain and those with mood disorders.

Chronic pain diagnoses are associated with opioid overdose and  to suicide: The association is mediated by the quantity of opioids prescribed.

These persons are also at greater risk for suicide.

Patients with a substance use disorder are at increased risk for suicide.

Difficulties in ascertaining the manner of death probably results in the und2242eporting of opioid-overdose deaths as suicides.

Patients with opioids use disorder motivation to live might be eroded by addiction, and therefore engage in increasingly risky behaviors despite a lack of conscious suicidal intent.

The CDC estimated that of 44,965 suicides in the United States in 2016, about 50% were carried out by firearm and about 15% by drug overdose.

The percentage of the estimated 42,000 opioid-overdose deaths in 2016 that were suicides is not well documented.

A challenge in determining the manner of death in opioid-overdose fatalities is that the medical examiner does not know the decedent’s intent with certainty.

The percentages of overdose deaths classified as undetermined vary ranging from 1% to 85% with an average of 8%.

Information from multiple sources strongly suggest that the proportion of opioid-overdose deaths that are suicides is considerable.

The diagnoses of any substance use disorder is associated with increased suicide risk.

Among persons with opioid use disorder, the suicide risk is 87 in 100,000 — six times the general U.S. population rate of 14 in 100,000; even after controlling for other suicide risk factors such as coexisting psychiatric diagnoses.

Opioid use disorder more than doubles the risk of suicide among women and increased the risk among men by 30%.

In 2014 data from the National Survey of Drug Use and Health showed that an opioid use disorder involving prescription opioids was associated with an increase of 40 to 60% in the risk of suicidal ideation.

People using opioids regularly are at greatest risk of suicide.

People using opioids are about 75% more likely to make suicide plans and twice as likely to attempt suicide as people who do not have any opioid use.

Suicidal ideation and attempts are predictors of eventual suicide.

2006–2011 data from the Nationwide Emergency Department Sample with information on more than 250,000 emergency department visits by adults for opiate overdose show that only 54% of the overdoses were classified as unintentional, 26.5% intentional, and 20.0% were undetermined: suggesting that the proportion of suicides among opioid-overdose deaths is somewhere between 20% and 30%.

The use of medications and drugs in combination with opioids can further increase risk of death.
The use of alcohol and cocaine increases the risk of death of both suicide and unintentional overdose.
The use of benzodiazepines are associated with an intentional overdose and suicide among individuals taking opioids.

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