Suicide by Opioid: Exploring the Intentionality of the Act.

Joseph Pergolizzi,Rohit Nalamasu,Giustino Varrassi,Peter Magnusson,Frank Breve,Jo Ann K Lequang

doi:10.7759/cureus.18084

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.

Highlights

BackgroundOpioid-induced respiratory depression is a potentially life-threatening consequence of opioid toxicity, but it is not always possible to determine if death from opioid overdose was accidental or intentional [1]
The exact number of Americans who died of an opioid overdose but whose deaths might be classified as suicide remains unknown
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

Summary

Introduction

Opioid-induced respiratory depression is a potentially life-threatening consequence of opioid toxicity, but it is not always possible to determine if death from opioid overdose was accidental or intentional [1]. People with active intent are trying to die of suicide, while those with passive intent know the risks of death but do not care Both groups understand the risks of opioid overdose. Many people who take opioids have chronic pain, OUD, or both, any of which may expose them to overwhelming hardships and difficulties Those taking opioids have access to familiar tools to attempt suicide and perhaps less reticence than others to consider suicide. Of those individuals who committed suicide and had a recent benzodiazepine exposure, half (50%) had filled a prescription for opioids in the past 30 days before death Of those who died by suicide by drug overdose, 48% had recent benzodiazepine exposure [28]. It is an important subject worthy of further deliberation

Conclusions

Disclosures

Findings

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