Objective

While public health efforts addressing opioid overdose morbidity and mortality focus on opioid use disorder (OUD), the possible link between opioid overdose and suicide remains relatively unexplored. The CDC estimates that about 7% of all opioid overdose deaths are suicides. It is important to understand the links between suicide and opioids, an increasingly dangerous issue which has not yet been fully addressed.

Methods

The authors reviewed the literature between March-April 2021 using the PubMed database to research the following keywords “suicide opioid,” “suicide chronic pain,” “suicide mental health.” This search was narrowed by focusing on clinical trials, randomized clinical trials and meta analyses. These articles were supplemented with articles located in the bibliographies of these articles as well as authoritative websites.

Results

Suicide is one of the leading causes of death in most developed countries and is increasing. Death by opioid overdose may be deliberate (intentional suicide), accidental, or it may be “passive” suicide by distressed individuals who take these medications recklessly and are ambivalent about their own safety. OUD is a risk factor for suicide and as much as 48% of all people with OUD will attempt suicide. But just as OUD is a risk factor, the abrupt discontinuation of prescribed opioids for chronic pain patients is also considered a risk for suicide. About one-third of all people with chronic pain contemplate suicide.

Conclusion

Suicide is associated with OUD, chronic pain, and mental health disorders, all of which may co-occur in certain individuals. As both suicide rates of opioid-related mortality increase, it should be considered that suicide by opioid may be an underestimated public health crisis.