By Pat Anson, Editor
Opioid pain medication is involved in less than 5 percent of the attempted suicides in the United States, according to a large new study of emergency room visits.
Researchers at Johns Hopkins University School of Medicine studied a national database of more than one billion emergency department visits from 2006 to 2013, and found that antidepressants and anti-anxiety drugs were far more likely to be used in an attempted suicide than opioid medication.
The findings appear to contradict numerous government and media reports suggesting that opioids play a significant role in the nation’s rising suicide rate. A recent VA study, for example, found that veterans receiving the highest doses of opioid painkillers were more than twice as likely to die by suicide.
According to the Centers for Disease Control and Prevention, suicides in the U.S. increased by 31 percent over the past decade and are now the 10th leading cause of death. In 2014, nearly 43,000 Americans committed suicide, three times the number of overdose deaths that were linked to prescription opioids.
The Johns Hopkins researchers were puzzled to find that while suicides had risen, there was no corresponding increase in attempted suicides. Their findings are published in the journal Epidemiology and Psychiatric Sciences.
"What stood out to us the most is that while the rate of fatal suicide has increased, the overall rate of nonfatal suicide attempts has not changed much over the years, nor have the patterns -- age, sex, seasonality, mechanism, etc. -- changed much," said lead author Joseph Canner, interim co-director of the Johns Hopkins Surgery Center for Outcomes Research.
Canner and his colleagues analyzed over 3.5 million emergency department visits involving patients who were admitted for attempted suicide or self-inflicted injury. Poisoning was the most common means of injury, accounting for two-thirds of all suicide attempts. Benzodiazepines, anti-anxiety medication, tranquilizers and antidepressants were the most commonly used drugs.
Codeine, morphine, methadone and other opioid medications were involved in only 4.9% of the suicide attempts.
The study confirmed that suicide attempts peak during the spring, dispelling the popular myth that suicides increase during the holiday season. Attempted suicides actually decreased in November and December.
Over 80 percent of those who were admitted for a suicide attempt suffered from a mental health disorder, a broad category that includes depression, anxiety, substance abuse and alcohol disorders.
There have been anecdotal reports of suicides increasing in the pain community since the release of the CDC’s opioid prescribing guidelines in March, 2016. But the guidelines – and their impact on suicides – did not fall within the study period. Johns Hopkins researchers also did not study the relationship between chronic pain and attempted suicide.
“The study fails to reflect, evaluate or acknowledge suicides after the crackdown on opioid analgesics to relieve chronic and intractable pain,” said Twinkle VanFleet, a chronic pain sufferer, patient advocate and suicide survivor.
“Chronic pain sufferers are at a higher risk in contemplation, ideations, and actual attempts on their lives due to the CDC guidelines being developed without consideration to the suffering… inflicting fear in providers to prescribe and fear in patients to live.”
Earlier this year, VanFleet said she became suicidal due to her own undertreated pain. She sought help from two doctors and also went to an emergency room – and was sent away all three times without treatment.
“I still don't know why I'm still here,” she said.