Suicides involving opioids more than doubled in 15 years, according to a new study — far less of an increase than opioid deaths overall, but one that nevertheless suggests a dangerous link between mental illness, pain, and intentional death.
Opioids are implicated in a small proportion of suicides, though the figure grew from about 2 percent to 4 percent between 1999 and 2014, according to National Center for Health Statistics data.
In many ways the findings of the new study paralleled patterns shown by earlier research for all opioid fatalities, the vast majority of them accidental: Suicide death rates involving opioids are increasing faster among women than men, and among middle-age Americans compared with younger people. Opioid-related suicides also are increasing faster among whites (who have long been more likely to die from both opioid use and suicide than nonwhites).
The analysis found that prescription painkillers were involved in 97.7 percent of opioid-related suicides. Heroin, a naturally derived opiate, was present in surprisingly few, just three-tenths of one percent. More than two-thirds of the deaths were at home.
The research team, led by the University of Washington, pointed out that the vast majority of suicide deaths involve mental illness and that people with histories of depression and post-traumatic stress disorder are more likely to be prescribed opioids — in higher doses and for longer time periods — for chronic pain compared with the rest of the population. Pain reliever prescriptions also are more common among those with substance abuse and borderline personality disorders.
The result is a difficult-to-break cycle of mental illness, pain, and access to the prescription drugs that can cause self-inflicted death.
"Opioids could potentially be a risk for suicide, as well as a means of suicide,” the researchers wrote in the March issue of the American Journal of Public Health.
There are many known risk factors for suicide, among them loss of a job, physical illness, feelings of hopelessness, and access to lethal means; some medical guidelines recommend that physicians screen for the presence of firearms in the home.
"The accessibility of opioids should be considered an additional risk factor for those already at high risk for suicide," the researchers concluded.