We’re just beginning to learn how many fatal overdoses aren’t accidents. To prevent those deaths, we need to understand them better.
When the Centers for Disease Control and Prevention reported last fall that U.S. life expectancy had suffered the longest running decline since World War I, experts pointed to rising suicide and overdose rates as two of the forces behind that drop. What didn’t make headlines: Some fatal overdoses are also suicides.
“Overdose and suicide are being treated as separate problems, but there is overlap in the causes that are driving increases in both,” said Amy Bohnert, an associate professor of psychiatry at the University of Michigan and the lead author of an article on opioid overdose and suicide published last week in The New England Journal of Medicine.
“The overdoses that are considered unintentional are a bigger driver, but suicides are contributing to the declining life expectancy as well,” she added.
According to the article, which analyzed CDC data from 2000 to 2017, about 10 percent of suicides were from intentional overdose. And of those, a third involved opioids.
In that period, deaths from suicide rose 60 percent, from 29,319 to 47,173, and the opioid-related suicide rate nearly doubled. In 2017, 1,887 Americans died of reported intentional opioid overdoses.
And that might be an underestimate.
A suicide note or a previous suicide attempt can be an indication that a drug overdose was intentional. But in the absence of such evidence, medical examiners may default to classifying an overdose as unintentional, which has led public health researchers to theorize that drug suicides are being undercounted.
An op-ed published in The New England Journal of Medicine in April, for example, estimated that as many as 30 percent of opioid overdoses may be suicides rather than unintentional deaths.