Posted on Jan 07, 2019, 7 p.m.
Opioids are a key contributor to the rise in suicide and drugs overdose rates that are killing American adults at double the rate today than they did just 17 years ago according to a new review and analysis conducted by researchers from the University of Michigan.
Turning the tide and reversing this deadly trend will take investment into programs designed and proven to prevent and treat opioid addiction, pain care, and mental health care. The team calls for more research into identifying those at most risk for deliberate or unintentional opioid overdoses, as published in the New England Journal of Medicine.
The number of deaths from suicides and unintentional overdoses together rose from 41,364 in 2000 to 110,749 in 2017 according to data from the CDC; when calculating a rate per 100,000 Americans to account for the rise in population in that time rates of these two causes of death were found to have risen from 14.7 to 33.7 in that time frame. When adjusted to include only suicides and overdoses listed as being caused by opioids these causes were found to account for more than 41% of such deaths in 2017 jumping up from 17% in 2000. In 2017 opioids were implicated in over ⅔ of all unintentional overdose deaths and ⅓ of all overdose related suicides; suicide notes were only found in ⅓ of overdose deaths making the motivations behind other overdoses less clear.
Links between overdoses, suicides, chronic pain and opioids of all kinds including those bought illegally and those prescribed by doctors were reviewed in their study; as well as current evidence for what is working to identify those at risk for overdose or suicide, and treatment for chronic pain, mental health conditions, and opioid use addiction.
Increases in overdose and suicide death rates in the past 2 decades parallels the rise in opioid painkiller prescriptions, and later the use of heroin and illegally manufactured fentanyl. The competing theories of whether increased supply of opioids from legal/illegal sources or an increased demand for them due to social and economic factors were to blame were investigated by the researchers. Both theories were noted to have validity and should be addressed through policy solutions, as due to common factors it may be possible to decrease the both death toll rates through increased use of proven prevention and treatment strategies.
According to the analysis for suicide and unintentional overdoses men had death rates twice as high as women; rates of suicide were highest among white men and American Indian/Alaska Native men; white men under 40 had the highest rates for unintentional overdoses; and risk of suicide and overdose increased among those with mental health conditions and substance abuse disorders.
The team calls for those on high dose regimens of opioids and those showing signs of misuse be given care to reduce risk while being guided through a tapering of their use. They suggest greater availability of medication assisted treatment for those with an opioid use disorder, counseling, and access to overdose medications such as naloxone. Reducing barriers to these can help to reduce the severity of opioid use disorder and improve mental health essential to addressing overdose and suicide.
Materials provided by Michigan Medicine - University of Michigan.
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Amy S.B. Bohnert, Mark A. Ilgen. Understanding Links among Opioid Use, Overdose, and Suicide. New England Journal of Medicine, 2019; 380 (1): 71 DOI: 10.1056/NEJMra1802148