One of the most serious issues in America’s growing youth addiction crisis is the question of suicidal intent among kids who overdose, especially on opioids.
That’s why a recent commentary from Dr. Yifrah Kaminer—Professor Emeritus of Psychiatry & Pediatrics at the University of Connecticut School of Medicine and part of the leadership council at the Foundation for Drug Policy Solutions—is so essential. Dr. Kaminer and his co-author Simon Zhornistky examined the ways in which suicidal intentionality, other mental illness, and the opioid- and sedative-driven addiction crisis interact.
To quote their work:
Substance use disorders and suicidal behavior share common risk factors, including co-occurring psychiatric disorders (Kaminer et al. 2020; Goldston et al. 2021) and high rates of adverse childhood events (Stein et al. 2017). Although the manner of death for most decedents by OD is accidental, the use of natural, semisynthetic (e.g., heroin), and synthetic (e.g., fentanyl, tramadol) opioids has been linked to increased suicide risk and what was determined as intentional OD (Bonhert & Ilgen, 2019; Oquendo & Volkow, 2018) . . . . Therefore, manner of death by suicide, leading to fatal intentional OD is a grave concern that cannot be overlooked (Connery & McHugh, 2021).
The information Kaminer and Zhornitsky gathered suggest that the issue is a complicated one. The literature around adult suicidal overdoses reveals difficulty in reliably assessing intentionality due to a number of factors—including both plans to conceal intent around a non-fatal overdose in order to manage a fatal overdose later, as well as cognitive damage caused by hypoxia and other physical problem overdoses can inflict.
But they note that
[t]he fatal OD rate among youth has been accounting for approximately 10% of deaths (Kaminer et al. 2023). Another major public health concern has been the continued increase in suicide amongst youth since the year 2007 (Han et al. 2018).
Some response, then, is clearly required. Above all? More research into the connection between suicidality and opioid overdose among adolescents, as well as further consideration given to an intervention proposed for adults:
[T]here has been a discussion in the adult literature regarding the value of consideration of civil commitment of individuals with repeated episodes of severe health and life risk consequences due to substance use including drug OD (Cavaiola & Dolan, 2016) . . . . Such a discussion is also necessary for considering the value and limitations for enacting determined preconditions and criteria for a civil commitment for youth at risk for drug OD, particularly when suicidal intentionality has been present.
Powerful food for thought.
Especially given the results of Kaminer and Zhornitsky’s March study in the American Journal on Addictions, which found a high prevalence of intentional overdose behavior among young adults receiving methadone treatment for opioid use disorder. That study examined a group of 18-26 year olds and found that a worrying 42% of them had a history of suicide attempts—and that 78% of the attempters reported more than one intentional overdose.