The Link Between Suicides and Unintentional Overdoses

Much has been written about increased rates of suicide in the United States. An article published earlier this year in the New England Journal of Medicine by Amy Bohnert and Mark Ilgen reviewed deaths from suicide, deaths from overdose, and opioid use.

Between 2000 and 2017, the death rate from suicide increased almost 35 percent. However, the rate of deaths from unintentional overdoses increased 450 percent during the same time period. When deaths from suicide and accidental overdoses are added together, the death rates more than doubled.

In 2000, the death rate from suicide was about 2.5 times higher than the rate from unintentional overdoses. By 2017, the death rate from unintentional overdoses had surpassed that from suicides and was about a third higher. This increase in deaths from unintentional overdoses can be almost fully explained by the dramatic increase in unintentional overdoses from opioids.

When Bohnert and Ilgen analyzed data for 2017, they found that death rates from suicide and unintentional overdoses varied substantially with age, gender, and race.

In general, death rates from both causes were about twice as high for men than for women and varied across age groups.

For white men, the suicide rate increased modestly across age groups (from 30 per 100,000 men for those between 18 and 40 years of age to about 35 per 100,000 for those 65 and older).

The death rate from overdose was highest among young white men (50 per 100,000) and lowest among those 65 and older (5 per 100,000).

Thus, for white men, the death rate was higher for overdoses than for suicides in young men, similar for suicide and overdoses in the middle-aged group, and much higher for suicide than overdoses in the elderly group.

The pattern was somewhat different for black men. The suicide rate decreased across age groups and was consistently lower than the rates for white men. The death rate from unintentional overdose was higher than the suicide rate for all age groups and was highest for the middle age group, which had a rate almost double the rates seen for the young and elderly groups.

The relationship between suicide and deaths from unintentional overdoses is a topic of active discussion in the medical literature. Some argue that many unintentional overdose deaths are “deaths of despair” and are actually suicides. In fact, sometimes it is difficult to determine whether a particular overdose death is unintentional or intentional.

Certainly, the increased availability of opioids and the concomitant rise in opioid use disorders are major factors responsible for the increased number of overdose deaths. Suicides and deaths resulting from unintentional overdoses represent a growing public health crisis in this country.

Much can be done to address the mental health concerns of individuals who are at risk of dying at their own hands with direct intent (suicide) or indirect intent (accidental overdose). This epidemic of death can be reversed if a concerted effort is made to address the interrelated issues of mental illness, including substance use disorders, and treatment of pain states. How many deaths will it take before we as a society decide that these conditions warrant major investments and concerted efforts in treatment?

This post was written by Eugene Rubin, M.D, Ph.D. and Charles Zorumski, M.D.

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