Opioid Use Disorder & Suicide

June 16, 2022

Table of Contents

In 2017, it was estimated that opioids were involved in over 40% of suicide and overdose deaths. Individuals with OUD have 13 times higher risk for suicide than for those without OUD.[1]

In 2019, nearly 50,000 people died of an opioid overdose in the United States.[1] Similarly, close to 50,000 Americans died by suicide in 2018.[2] 

The suicide rate in the U.S. population is 14 out of every 100,000, while the suicide rate among people with OUD is a staggering 86.9 out of every 100,000.[4] OUD raises the risk of suicide by nearly a third in men and more than doubles it for women. 

There is a distinct connection between opioid use disorder and suicide. It is likely that rates of suicide involving opioids are even underreported.

High-Risk Populations

People who misuse prescription opioids have between 40% and 60% greater odds of suicidal thoughts. Those with OUD involving prescription opioids are two times more likely to attempt suicide than those who are not misusing these medications.[5]

Psychiatric conditions and chronic pain increase the odds for misusing opioids, developing an OUD, and suicide.

High-risk populations include people with the following:

  • Chronic pain: Chronic pain can be a risk factor for both OUD and suicide, as it can cause brain chemistry and circuitry changes that alter the reward system.[6] Opioids offer temporary relief of pain; however, they are highly addictive substances. The longer someone takes them, the more dependent they can become on them.

    Chronic pain can significantly decrease a person’s quality of life, increasing the risk for substance misuse, mental health disorders, and suicide.
  • Veterans: Rates of both suicide and OUD are higher among veterans than non-veterans, with suicide rates 1.5 times higher and OUD rates 7 times higher.[7] Veterans are likely to experience injuries and trauma during their time in service. These experiences can result in chronic pain or mental health conditions, such as PTSD, anxiety, and depression. All of these factors can increase risk of OUD and suicide.
  • Depression: Nearly three-quarters of people dependent on opioid drugs also have at least one psychiatric comorbid disorder, with mood and anxiety disorders being the most common (35% and 50% respectively).[8] Depression, common with OUD, is one of the biggest risk factors for suicide.
  • Anxiety: People who have a mood disorder, such as anxiety, are two times as likely to also have a substance use disorder (SUD). People with anxiety are also at an elevated risk for suicide. Combined anxiety and OUD lead to a higher rate of suicide.
  • Personality disorders: Personality disorders, including borderline personality disorder (BPD), often include risk-taking behaviors and impulsivity. When combined with substance use, this can put patients at risk of self harm or suicide.

Other Risk Factors

People with a history of psychiatric treatment, those of a younger age, and people with a history of opioid and alcohol use have higher rates of completed suicides than those without these risk factors.[9]

Childhood trauma is a big risk factor for both the development of SUD as well as suicide. The brain is not fully formed until young adulthood. Drug use in adolescence can cause dysfunctional brain formation, lead to emotional , ineffective coping, poor decision-making and poor executive functions. All of these can lead to increased risk of self harm and/or suicide.

Signs of OUD & Suicide

Some of the best methods for managing OUD and helping to prevent suicide are knowing what to look for. 

Signs of OUD:

  • Mood swings, behavior changes, and personality shift
  • Taking more opioids than intended to in a setting (opioid misuse)
  • Inability to stop using opioids despite trying several times
  • Changes in appearance and lack of attention to personal hygiene and self-care
  • Shifts in appetite and sleep patterns
  • Social withdrawal and isolation
  • Using opioids in potentially hazardous situations
  • Continuing to use opioids despite knowing that they are causing social, physical, and/or mental health issues
  • Decreased interest in events or activities that were previously prioritized
  • Majority of the time spent taking opioids, thinking about getting them, and recovering from their effects
  • Drug tolerance (needing to take more opioids to feel their effects)
  • Flu-like withdrawal symptoms, sleep issues, and low moods when opioids wear off

Warning Signs of Suicide:

  • Increased alcohol and/or drug use
  • Talking about wanting to die or suicidal ideations
  • Agitation or anxiety
  • Acting reckless and impulsive
  • Self-isolation and social withdrawal
  • Extreme mood swings
  • Sleeping a lot or not enough
  • Feeling like a burden
  • Feeling hopeless and without a purpose
  • Talking about being in unbearable pain or feeling trapped
  • Discussions of revenge or showing rage
  • Making a plan and looking up methods for death
  • Giving away important items, making a will, and saying goodbye 

Causes of Suicide & OUD

There are overlapping causes for OUD and suicide, which can involve similar brain functions or circuitry as well as similar risk factors like childhood trauma, mood and behavioral disorders, and chronic pain.

Opioids change the way your brain responds to pleasure, which can make the lows even lower when they wear off, thus raising the risk for suicide. Executive functioning, decision-making, and impulse control are all impacted by opioid use, which can also elevate the odds for suicide.

There are also specific factors that can contribute to suicide or the development of an OUD.

Contributing factors to suicide:

  • Mental health conditions
  • Trauma
  • Stress
  • Chronic pain
  • Bereavement
  • Financial strain
  • Housing difficulties
  • Conflict with a spouse or romantic partner
  • Substance abuse and SUD
  • Exposure to suicidal behavior
  • Violence in the home
  • Recent release from prison or jail
  • Presence of firearms in the home or easy access to lethal means
  • Family history of mental illness, substance abuse, and/or suicide

OUD causes:

  • Biology and brain function
  • Family history of drug use and addiction
  • Mental health conditions
  • Drug use at a young age
  • High levels of stress
  • Lack of family and social support
  • Living in a high-risk environment
  • History of substance abuse

Prevention

Awareness is the best prevention methods for OUD and suicide. Education on opioids, their dangers, and risk factors for suicide can help. 

It is important to dispose of opioids properly and keep them stored in a safe manner. When you need opioid medications, take them exactly as directed and do not deviate from your prescription’s instructions.

Increased social support can help to minimize the risk for both opioid misuse and suicide. Healthy coping mechanisms for stress and emotional regulation skills are beneficial. 

If someone is struggling with mental health or substance misuse, a trained professional can help.

What to Do if You Think Someone Is at Risk of Self-Harm or Suicide

In 2019, approximately 12 million adults in the United States had serious thoughts about suicide.[11] Suicide is one of the top 10 leading causes of death in America and needs to be taken seriously.

If you think a loved one is at risk of harming themselves, take action! Do not leave them alone or promise to “keep it secret”.

Seek professional help. If you think someone is in immediate danger or crisis, call 911 or take them to the nearest emergency room. You can also contact the National Suicide Prevention Lifeline.[12]

Prevention of Intentional (or unintentional) Opioid Overdose

If a patient intentionally takes a high dose of opioids in order to attempt suicide, Narcan can be administered either intranasally (by spraying into the nose) or intramuscularly (injected). Anyone who has a prescription for an opioid, or is known to be using opioids illicitly, should seek a prescription for Narcan from a local pharmacy. Most states offer Narcan over the counter without a prescription necessary, in order to make sure anyone with OUD or any family or friend of someone using opioids can obtain the medication and be ready to administer it properly in case of an attempted (or accidental!) overdose.  If you have trouble obtaining Narcan over the counter, reach out to your doctor and ask them to help you obtain a Narcan prescription so you can always have it ready. Once Narcan is administered, call 911 immediately. There are no repercussions or punishments for any observer that calls 911 in an attempt to prevent an overdose.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Opioid Use and Suicide Risk. U.S. Department of Veterans Affairs (VA). https://www.mentalhealth.va.gov/suicide_prevention/docs/Literature_Review_Opioid_Use_and_Suicide_Risk_508_FINAL_04-26-2019.pdf. April 2019. Accessed February 2022.
  2. Drug Overdose Deaths. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/drugoverdose/deaths/index.html March 2021. Accessed February 2022. 
  3. 10 Leading Causes of Death by Age Group, United States- 2018. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_by_age_group_2018_1100w850h.jpg 2018. Accessed February 2022.
  4. Opioid Use Disorders and Suicide: A Hidden Tragedy (Guest Blog). National Institute on Drug Abuse (NIDA). https://archives.drugabuse.gov/about-nida/noras-blog/2017/04/opioid-use-disorders-suicide-hidden-tragedy-guest-blog April 2017. Accessed February 2022.
  5. Suicide Deaths are a Major Component of the Opioid Crisis that Must be Addressed. National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/about/director/messages/2019/suicide-deaths-are-a-major-component-of-the-opioid-crisis-that-must-be-addressed September 2019. Accessed February 2022.
  6. Understanding Links Among Opioid Use, Overdose, and Suicide. The New England Journal of Medicine (NEJM). https://www.nejm.org/doi/full/10.1056/NEJMra1802148. 2019. Access February 2022.
  7. Drug Overdose and Suicide Among Veteran Enrollees in the VHA: Comparison Among Local, Regional, and National Data. Federal Practitioner. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7535957/ February 2020. Accessed February 2022.
  8. Suicide Risk and Addiction: The Impact of Alcohol and Opioid Use Disorders. Current Addiction Reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955902/ March 2021. Accessed February 2022.
  9. Suicide Among People Treated for Drug Use Disorders:  a Danish National Record-Linkage Study. BMC Public Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955902/ January 2020. Accessed February 2022. 
  10. Pain, Opioids, and Suicide Mortality in the United States. Annals of Internal Medicine. https://www.acpjournals.org/doi/full/10.7326/M18-2330 October 2018. Accessed February 2022.
  11. Suicide Prevention. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/suicide/index.html. January 2022. Accessed February 2022.
  12. National Suicide Prevention Lifeline. Substance Abuse and Mental Health Services Administration (SAMHSA). https://suicidepreventionlifeline.org/. Accessed February 2022.

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