Suicides Involving Opioids May Be Underreported
by Phillip M
The American Foundation for Suicide Prevention reports that suicide is ranked as the 10th most common cause of death in the United States, leading to the deaths of nearly 45,000 people in this country every year. However, recent studies indicate these statistics may not be entirely accurate. One particular type of suicide—suicide by opioid overdose—is thought to be underreported in the United States.
The Opioid Epidemic
The abuse of opioids in the United States has been increasing dramatically in recent years. In many cases, opioid abuse leads to the death of the user. In fact, according to the American Society of Addiction Medicine, opioid overdose took the lives of more than 20,000 people just in 2016. Because of this increase in drug overdose fatalities, drug overdose is now the leading cause of accidental death in the United States.
About the Study
The study in question was conducted by researchers at UCLA and published online in the January issue of the journal PLOS ONE. The report was co-authored by Mark Kaplan, who works at the UCLA Luskin School of Public Affairs as a professor of social welfare.
According to this study, a significant portion of opioid deaths in the United States could be incorrectly classified as “accidental poisoning,” when they were actually suicides. This conclusion is based in part on a change in statistics related to drug suicides and drug-intoxication deaths. From 2000 to 2016, the accidental drug death rate rose by 312 percent, while the drug-intoxication suicide rate increased by 24 percent. The gap between these two rates indicates a possible undercounting of drug-intoxication suicides.
Why Are Drug Suicides Underreported?
One problem that may be contributing to the underreporting of opioid overdose suicide incidences is a lack of thorough investigation when drug-overdose deaths occur. When someone commits suicide by opioid overdose, it isn’t always obvious the overdose was intentional. Other, more violent means of suicide don’t require as much investigation because the intention of the victim is easy to see. However, to determine whether an opioid overdose resulting in death was accidental or intentional, a more intensive level of investigation is required. Although suicide notes can be helpful to investigators in these investigations, people who commit suicide often fail to leave a note, with suicide notes included as evidence in less than one-third of all suicides.
Unfortunately, throughout the United States, local and state death investigation systems don’t have the resources they would need to thoroughly investigate opioid overdose deaths. As a result, many deaths that may have been suicides are ruled accidental self-poisoning. The researchers who published this study assert the problem is most likely worse among middle-aged people.
Another issue that may contribute to the underreporting of this type of suicide is the stigma surrounding suicide itself. Coroners and medical examiners are reluctant to designate a death as suicide in the absence of clear evidence, as doing so can cause more trauma for friends and family members. Instead, they choose to classify the death as “undetermined” or “accidental.” In addition, suicide determination is not standardized, leading to differences in classification techniques across the country that may cause statistics to be inaccurate.
Yet another factor contributing to this problem is the sheer number of opioid overdose deaths. The incidence of this type of death continues to increase, overwhelming coroners and medical examiners all over the country. In areas where opioid abuse is particularly high, coroners and medical examiners have a tendency to rule deaths accidental unless clear evidence to the contrary exists. This problem may be especially pervasive in cases involving a person with a known opioid addiction. However, history of opioid addiction does not rule out suicide by opioid overdose. In fact, some addicts may choose to commit suicide in this way because they are unable to overcome their addiction.
Understanding the true number of opioid overdose suicides would be beneficial for many different reasons. For example, showing the number of suicides performed in this way is higher than currently believed would draw more attention to the pervasive mental health issues of addiction and depression, which often occur together. Classifying individual deaths more accurately would also help bring closure to the families of overdose victims.
Investigators considering the cause of an opioid overdose can increase their accuracy by considering the individual’s history. Factors such as diagnosed depression, a previous suicide attempt, or actions indicating a tendency toward suicide prior to the event may provide insight. However, in many cases, no clear evidence is available.
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