Suicide plays smaller role in opioid deaths than thought

December 17, 2019

Columbia researchers, analyzing national data on opioid overdose deaths, have found that only 4% of opioid-related overdose deaths are due to suicide--far below recent estimates of 20-30%.

The findings were published today in JAMA.

"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," says the study's leader Mark Olfson, MD, MPH, the Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law at Columbia University Vagelos College of Physicians and Surgeons.

The study is the first to use national data on opioid overdose deaths between 2000 and 2017 to find out what share of these deaths in individuals age 15 and older were unintentional, due to suicide, or of undetermined intent.

Over the 17-year study period, the percentage of opioid-related overdoses attributed to suicide decreased from 9% to 4%.

However, the rate of opioid-related suicide deaths more than doubled, from 0.27 to 0.58 per 100,000 people, and the rate of unintentional deaths increased over six-fold, from 2.20 to 13.21 per 100,000 people. (Although the percentage of overall opioid-related deaths that were undetermined in intent decreased from approximately 17% to 5%, their rate increased from 0.51 to .79 per 100,000.)

"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," says Olfson.

Though the researchers did not find a close link between opioid overdose deaths and suicide deaths--two ongoing public health crises--they note that the increase in suicide deaths in the U.S. may still be driven, at least in part, by the rise in opioid overdose deaths because of the absolute increase in opioid-related suicide deaths.

Additional research is needed to understand the role of suicidal intent in opioid overdoses, say the authors. "Considering the high risk of suicide after nonfatal opioid overdose, this information could be especially valuable in suicide prevention efforts," Olfson says.

"This type of rigorous research accessing large sets of data is essential to understanding and alleviating the social and clinical factors adversely affecting the health of our population," adds Jeffrey A. Lieberman, Chair of the Department of Psychiatry at Columbia University Vagelos College of Physicians and Surgeons.
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More Information

The article is titled, "Trends in intentional and unintentional opioid-overdose deaths in the United States, 2000-2017."

The other authors are Lauren Rossen (National Center for Health Statistics, Hyattsville, MD), Melanie Wall (Columbia University Vagelos College of Physicians and Surgeons, New York, NY), Debra Houry (Centers for Disease Control and Prevention, Atlanta, GA), and Carlos Blanco (National Institute on Drug Abuse, Bethesda, MD).

The study was completed without external funding.

The authors report no financial or other conflicts of interest.

Columbia University Irving Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the Vagelos College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Irving Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cuimc.columbia.edu or columbiadoctors.org.

The Columbia University Department of Psychiatry is among the top ranked psychiatry departments in the nation and has contributed greatly to the understanding and treatment of brain disorders. Co-located at the New York State Psychiatric Institute on the NewYork-Presbyterian Hospital/Columbia University Irving Medical Center campus in Washington Heights, the department enjoys a rich and productive collaborative relationship with physicians in various disciplines at the Columbia University Vagelos College of Physicians and Surgeons. Columbia Psychiatry is home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders, eating disorders, substance use disorders, and childhood psychiatric disorders.

Columbia University Irving Medical Center

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