Opioid Use Disorders and Suicide
ByDr.Fourkan Ali
In 2015, over 33,000 Americans
died from opioids—either prescription drugs or heroin or, in many cases, more
powerful synthetic opioids like fentanyl. Hidden
behind the terrible epidemic of opioid overdose deaths looms the fact that many
of these deaths are far from accidental. They are suicides.
Let me share with you some
chilling data from three recent studies that have investigated the issue.
In a study of nearly 5 million
veterans recently published in Addiction, scientists reported that presence of a
diagnosis of any substance
use disorder and specifically diagnoses
of opioid use disorders (OUD) led to increased risk of suicide for
both males and females. The risk for suicide death was over 2-fold for
men with OUD. For women, it was more than 8-fold. Interestingly,
when the researchers controlled the statistical analyses for other factors,
including comorbid psychiatric diagnoses, greater suicide risk for females
with opioid use disorder remained quite elevated, still more than two times
greater than that for unaffected women. For men, it was 30 percent
greater. The researchers also calculated that the suicide rate among
those with OUD was 86.9/100,000. Compare that with already alarming rate
of 14/100,000 in the general US
population.
You may be tempted to think that
these shocking findings about the effects of OUD on suicide risk are true for
this very special population. But that turns out not to be the
case.
Another US study,
published last month in the Journal of Psychiatric Research, focused on 41,053
participants from the 2014 National Survey of Drug Use and Health. This
survey uses a sample specifically designed to be representative of the entire US
population. After controlling for overall health and psychiatric
conditions, the researchers found that prescription opioid misuse was
associated with anywhere between a 40 and 60 percent increased risk for
suicidal ideation (thoughts of suicide). Those reporting at least weekly
opioid misuse were at much greater risk for suicide planning and attempts than
those who used less often. They were about 75 percent more likely to make
plans for a suicide and made suicide attempts at a rate 200 percent greater
than those unaffected.
Using a different strategy, a
review of the literature in the journal Drug and Alcohol Dependenceestimated standardized
mortality ratios for suicide. This is a way of comparing the risk of
death in individuals with a given condition compared to individuals from the
general population. The researchers found that for people with OUD, the
standardized mortality ratio was 1,351 and for injection drug use it was
1,373. This means that compared to the general population, OUD and
injection drug use are both associated with a more than 13-fold increased risk
for suicide death.
These are stunning numbers and
should be a strong call to action.
Persons who suffer from OUD are
highly stigmatized. They often talk about their experience that others view
them as “not deserving” treatment or “not deserving” to be rescued if they
overdose because they are perceived as a scourge on society. The
devastating impact of this brain disorder needs to be addressed. People
who could be productive members of society and contribute to their families,
their communities, and the general economy deserve treatment and attention.
As a country, we desperately need
to overcome stigmatizing attitudes and confront the problem. We need to
understand what causes some individuals to become addicted when exposed to
opioids and thus study the biological basis of the disease of opioid addiction.
We desperately need to know what the best treatments are for a given
individual, and for that too, we need research to identify biomarkers for
treatment response. And given the fact that effective medications exist but are
drastically underutilized, we need to overcome institutional and attitudinal
barriers to these treatments and deliver them to the 24 million people who
could benefit. It can prevent not only the suffering of addiction and the
danger of unintentional overdose but also help prevent the tragic outcome of
opioid-related suicide.
The writer Teacher and Columnists
01611579267
Dr.fourkanali@gmail.com
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