Abstract
ObjectiveTo examine prevalence, demographic, and incident factors associated with opioid-positivity in Illinois suicide decedents who died by causes other than poisoning.MethodCross-sectional study of Illinois’ suicide decedents occurring between January 2015 and December 2017. Data come from the National Violent Death Reporting System. We used Chi-square tests to compare decedent and incident circumstance characteristics by opioid toxicology screen status. Incident narratives were analyzed to obtain physical and mental health histories and circumstances related to fatal injury events.ResultsOf 1007 non-poisoning suicide decedents screened for opioids, 16.4% were opioid-positive. White race, age 75 and over, and widowed or unknown marital status were associated with opioid-positivity. Among opioid-positive decedents, 25% had a history of substance use disorder (SUD), 61% depression, and 19% anxiety. The majority (52%) of opioid-positive decedents died by firearm, a higher percentage than opioid-negative decedents.ConclusionThe opioid overdose crisis largely has not overlapped with non-poisoning suicide in this study. Overall, our analyses have not identified additional risk factors for suicide among opioid-positive suicide decedents. However, the overlap between opioid-positivity, SUD, and physical and mental health problems found among decedents in our data suggest several suicide prevention opportunities. These include medication assisted treatment for SUD which has been shown to reduce suicide, screening for opioid/benzodiazepine overlap, and limiting access to lethal means during opioid use. Improved death scene investigations for substances and use of the Prescription Drug Monitoring Program to document prescriptions are needed to further understanding of the role of substances in non-poisoning suicide.
Highlights
The opioid misuse crisis has drawn attention to drug overdose deaths including unintentional and suicide poisoning deaths
As it is well known that opioid use and misuse is associated with suicidal ideation and attempts [4], it is plausible that opioids may play a role in suicide deaths by causes other than poisoning
Our study findings suggest that opioid positivity is not common among non-poisoning suicide decedents despite the ubiquitous nature of the opioid crisis in the Physical health problem contributed to death Physical health problem was a crisis Had a non-alcohol related substance abuse problem^ Prior suicide attempts Left a suicide note Disclosed suicidal thoughts/plans Identified as having a current mental health problem *P ≤ 0.000 ^ referred to as substance use disorder
Summary
The opioid misuse crisis has drawn attention to drug overdose deaths including unintentional and suicide poisoning deaths. In 2018, in the U.S, there were 46,802 opioid-involved overdose deaths [1]. On the face of it, it would appear that the opioid misuse crisis has not intersected with suicide as signaled by the decline in suicide deaths due to poisoning. As it is well known that opioid use and misuse is associated with suicidal ideation and attempts [4], it is plausible that opioids may play a role in suicide deaths by causes other than poisoning. This study goes beyond existing research on suicide and opioids to examine opioid involvement, as measured by the presence of opioids below the lethality threshold, in suicide decedents by causes other than poisoning, such as firearm and suffocation, which are leading causes of death among suicide decedents
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