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Opioid Overdose Suicide Rates Show Need for Routine Dual Diagnosis

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As hard as it may be to believe, we still have a lot of privacy in this country.

For instance, when you die, it isn’t always clear how you died.

  • If your heart is stopped and there are no visible wounds, it could be natural causes: heart disease, high blood pressure, etc.
  • If drugs are found in the bloodstream, they could be the cause or they might have been prescribed for a condition that finally caused death.
  • If they are not appropriate therapeutic drugs, it could be an overdose or an accidentally fatal combination of multiple drugs.
  • On the other hand, it could be a deliberate death by overdose: suicide.

Just as drug overdose deaths in the US have been rising—from less than 20,000 in 1999 to more than 72,000 in 2017—so have suicide rates. According to the Centers for Disease Control and Prevention (CDC), from 1999 to 2016, the rate of suicides among people ages 10 and older has increased in 49 of the 50 states, ranging from 6% in some states to 58% in others. (Nevada saw a 1% decrease in that same period.)

What hasn’t been widely considered until now is that some of these opioid overdose deaths may not be due to accidental overdoses but deliberate suicide. We know this because some of the unsuccessful opioid overdose suicides have admitted it.

“Within the opioid epidemic, there may be a hidden suicide epidemic,” Michigan State University Jennifer Johnson said. She will now study the issue with a $1 million grant from the National Institute of Mental Health.

Part of the problem in distinguishing between accidental death and suicide is that often mental illness and drug addiction are treated as separate and unrelated problems when statistics show they co-occur about half the time. When that happens, it is known as dual diagnosis, co-morbidity, co-occurring disorders or (in Canada) concurrent disorders.

The problem with dual diagnosis is that it often goes unrecognized. It is misidentified as drug addiction or mental illness alone, and one condition goes untreated. If both conditions aren’t treated, and as near as possible at the same time, both likely will recur.

According to suicide prevention organization Suicide Awareness Voices of Education (SAVE), patients with such dual diagnosis are at greater risk of attempting suicide because “Drugs and alcohol can worsen underlying mental illnesses.” Because a patient with a mental illness may take drugs as an attempt at self-medication, they are greater risk coming and going:

  • Mental illness symptoms, such as depression, may increase under the influence, leading to a suicide attempt.
  • During withdrawal the mental illness symptoms that led to the drug or alcohol use may return, leading to a suicide attempt.
  • Even realizing that they are mentally ill or addicted to drugs may cause the patients to despair that they will ever get better, leading to a suicide attempt.

While many experts now agree that opioid suicides have been under-counted, others also warn that considering all overdose deaths as suicides is an overreaction in the other direction.

Clearly, more research is needed and is being conducted. Whether these deaths are suicides or accidents, there are too many. The solution must be multi-pronged and it must include dual diagnosis treatment.