Suicide by Opioid: Exploring the Intentionality of the Act

Abstract

Opioid toxicity can result in life-threatening respiratory depression. Opioid-overdose mortality in the United States is high and increasing, but it is difficult to determine what proportion of those deaths might actually be suicides. The exact number of Americans who died of an opioid overdose but whose deaths might be classified as suicide remains unknown. It is important to differentiate between those who take opioids with the deliberate and unequivocal objective of committing suicide, that is, those with active intent, from those with passive intent. The passive-intent group understands the risks of opioid consumption and takes dangerous amounts, but with a more ambiguous attitude toward suicide. Thus, among decedents of opioid overdose, a large population dies by accident, whereas a small population dies intending to commit suicide; but between them exists a sub-population with equivocal intentions, waxing and waning between their desire to live and the carelessness about death. There may be a passive as well as active intent to commit suicide, but less is known about the passive motivation. It is important for public health efforts aimed at reducing both suicides and opioid-use disorder to better understand the range of motivations behind opioid-related suicides and how to combat them.

Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries

“…Data from more recent months may represent an undercount in suicides, although we cross-checked current and previous counts for the four months from 1st April 2020 for countries/areas-within countries that were in our earlier study 4 and found an average increase of <5%. Suicides may not have been as well captured as usual during the pandemic because of parallel events and/or resourcing issues (e.g., there are concerns that some US suicides are now being recorded as drug overdoses because they are occurring alongside the opioid crisis and medical examiners and coroners have been overwhelmed with COVID-19 deaths 35 ).…”

Polypharmacy and Healthcare Service Use Among Prescription Opioid Poisoning Cases Age 50+

“…36 However, discerning unintentional from intentional misuse/ abuse and suicide attempts may be difficult as the intentionality of overdose tends to be dimensional rather than categorical with shared risk factors. 36,37 Multivariable analyses showed that all co-used medications except antidepressants and NSAIDs were associated with significantly increased risks of noncritical and critical care admissions, and each additional medication increased such risks substantially. These findings largely support our hypotheses.…”

“…36 However, discerning unintentional from intentional misuse/abuse and suicide attempts may be difficult as the intentionality of overdose tends to be dimensional rather than categorical with shared risk factors. 36,37…”

Drugs increase the risk of suicide in the elderly

“…According to estimates by the Centres for Disease Control and Prevention (CDC), suicides account for approximately 7% of all opioid overdose deaths. Opioids may lead to the occurrence of opioid use disorder (OUD) and thus cause abnormalities in the course of mental processes, including the reward system [21]. Q.…”