Analysis of National Survey on Drug Use and Health (NSDUH) data showed that people with opioid use disorder were 1.88 to 4.17 times more likely to have suicidal ideation than people without the disorder. They were 3.35 to 6.7 times more likely to have made a suicide plan, and 2.8 to 10 times more likely to have attempted suicide. The paper was published in. Psychiatric Research Journal.
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Opioids are a type of drug that reduce pain and produce a feeling of euphoria by acting on specific receptors in the brain and body. These include natural, semi-synthetic, and synthetic substances such as morphine, heroin, and fentanyl. Opioids are commonly prescribed for pain management, but they carry a high risk of dependence and misuse. When this risk materializes, opioid users can develop opioid use disorder.
Opioid use disorder is a medical condition characterized by problematic patterns of opioid use that cause significant impairment and distress. This includes symptoms such as craving, loss of control of use, and continued use despite adverse consequences. People with opioid use disorder often develop a tolerance, requiring higher doses of the substance to achieve the same effect. When opioid use is reduced or stopped, people also experience withdrawal symptoms.
This disorder negatively impacts physical health, mental health, and social functioning. It is associated with an increased risk of overdose, which can be life-threatening. Importantly, research shows that approximately 20% to 30% of opioid overdose deaths are intentional, meaning suicide.
Study author William H. Craft and colleagues noted that health care professionals may be overlooking suicide risks in cases of mild or moderate opioid use disorder and may primarily associate those risks only with severe cases. They conducted a study examining the association between opioid use disorder severity and suicidality in a nationally representative US dataset.
They analyzed data from the 2021-2023 National Survey on Drug Use and Health (NSDUH), a nationally representative survey of noninstitutionalized civilians ages 12 and older. However, in this particular analysis, the researchers focused only on adults 18 years and older. The survey collects extensive data on drug use and mental health, including opioid use, suicidal thoughts, plans, and attempts.
The data used in this analysis were obtained from 139,524 participants. The study authors analyzed data on opioid use disorder severity and suicidality, as well as various demographic characteristics.
Results showed that just under 2% of study participants had suffered from opioid use disorder in the past year. Of these, 62.9% had mild symptoms of disability, 15.9% had moderate symptoms, and 21.2% had severe symptoms. Among individuals without opioid use disorder, 4.8% reported suicidal ideation, 1.3% reported a suicide plan, and 0.6% reported a suicide attempt in the past year. For participants with mild opioid use disorder, these rates jumped to 11.3%, 4.9%, and 1.9%, respectively.
Among people with moderate opioid use disorder, the proportions reporting suicidal ideation, suicide plans, and attempts in the past year were 12.0%, 8.4%, and 6.6%, respectively. The proportion of people with symptoms of severe opioid use disorder was 25.2%, 12.9%, and 8.4%.
In other words, people with opioid use disorder were approximately 1.9 to 4.2 times more likely to have suicidal ideation than those without opioid use disorder. They were 3.35 to 6.7 times more likely to have made a suicide plan, and 2.8 to 10 times more likely to have attempted suicide. Of note, this study found that the risk of suicide attempts increased dramatically in moderate cases and remained high in severe cases as well, suggesting that risky behaviors may emerge earlier in the progression of the disorder than expected. Importantly, the researchers found that while comorbid depression explained some of these risks, opioid use disorder remained independently associated with higher suicide rates.
“These findings suggest that OUD (opioid use disorder), regardless of severity, is associated with a significantly increased risk of suicidal ideation, suicide plans, and suicide attempts. This highlights the continued need to incorporate suicide screening and prevention into OUD treatment and clinical settings, such as primary care, where opioids are frequently prescribed,” the study authors concluded.
This study contributes important knowledge about opioid use disorder. However, it should be noted that the cross-sectional design of the study does not allow causal inferences to be drawn from the results. Additionally, the data are based on self-report, leaving room for recall bias and social desirability bias. This estimate is also likely to be conservative because of survivorship bias (people who died from suicide attempts could not be included) and because studies exclude institutionalized people, such as incarcerated and non-incarcerated people, who often have higher prevalence of the disorder.
The paper, “Opioid use disorders of all severity are associated with increased suicide rates,” was authored by William H. Craft, Keith Humphries, Michael J. Ostacher, and Claudia B. Padula.
