Incidence and Lethality of Suicidal Overdoses by Drug Class

Abstract

IMPORTANCEPrior lethality analyses of suicide means have historically treated drug poisoning other than alcohol poisoning as a lumped category. Assessing risk by drug class permits better assessment of prevention opportunities. OBJECTIVE To investigate the epidemiology of drug poisoning suicides.

Women, opioid use and addiction

“…5 A cross-sectional study of national and state-based samples totaling over 400,00 drug suicide attempts resulting in 21,594 deaths indicate that 54% of opioid-related lethal suicidal drug overdoses occur in women. 36 National survey data from the 2014 NSDUH of past-year frequency of prescription opioid misuse show a positive association with past-year suicidal ideation, planning, and attempts, with the strength of these relationships significantly stronger for women compared to men. 37 Importantly, after controlling for mental and general health and demographic characteristics, the same data did not reveal gender differences in these relationships suggesting the importance of these factors in assessing suicidality in women.…”

Lethality-Associated Factors in Deliberate Self-Poisoning

“…Around one in three patients with DSP using OTC drugs (89 cases) were from the adolescent group, and OTC overdose cases also accounted for 40% of all adolescent suicide patients [ 22 ]. Several previous studies have addressed the need to control access to drug types that increase the mortality rate of drug overdose [ 22 ]. An implication of our findings is the potential for careful management of OTC drugs that can be a way to reduce adolescents’ suicide attempts.…”

New Evidence to Help to Prevent Lethal Outcomes in Intentional Overdoses

“…A logical conclusion supported by the article by Miller et al 2 is to advise families of at-risk patients to keep on hand only the quantity of needed medications that, even if taken together, will do no serious harm. Measures of a drug's relative toxic effects, like the median lethal dose, are available, but most overdose attempts involve more than 1 drug, often combined with alcohol, and toxic effects can be higher when drugs are taken in combination.…”

“…They report that if substances taken in overdose included opioids or barbiturates, the risk of a fatal outcome was increased 5-fold and 4-fold, respectively. 2 In some models, relative risk was also increased for insulin and other diabetes drugs, calcium channel blockers, and antidepressants. 2 Their research did not examine the extent to which these relative risks are a function of potential moderating factors, such as which drugs happen to be on hand and in what quantity, patient behavior (eg, quantity taken, whether the patient purposely selected the drugs vs took what was at hand, whether they aborted the attempt), circumstances (eg, whether someone summoned help), or the drug's actual toxic effects (eg, whether the drug contributed chemically to death).…”

“…7 Becoming suicidal is not a death sentence. In their roles as prescribers, healers, and advisors, physicians can help to reduce both the likelihood of an attempt and, with the help of research like that by Miller et al, 2 the risk that an attempt will prove fatal.…”