When President Trump declared the opioid crisis a public health emergency Thursday, he noted that “last year we lost at least 64,000 Americans to overdoses.” He is not incorrect. A preliminary analysis for 2016 from the Centers for Disease Control and Prevention estimated the toll at 64,070, up from 52,898 in 2015.
What rarely gets mentioned in these staggering figures is that a significant number of opioid deaths are considered to be suicides. In 2015, 4,837 opioid-related fatalities were coded as “intentional self-poisoning” — 9% of all deaths. Another 2,553 were of undetermined cause, and 35 were assaults. All the others were considered accidents.
The real number of suicides may be higher. Experts says there are many challenges and inconsistencies when it comes to deciding if any drug-related fatality was intentional.
“It can be a tricky call to distinguish an intent to kill oneself from an accidental overdose when the person has died, unless there’s some other indication that a person has been engaging in what we call ‘preparatory behavior’” such as writing a will or stockpiling pills, says Dr. Gregory K. Brown, Director of the Center for the Prevention of Suicide at the Perelman School of Medicine of the University of Pennsylvania.
This is particularly true for those who have struggled with addiction. “People can get into a state where they don’t care if they live or die,” Brown says.
In 2011, the CDC proposed guidelines for additional data collection in cases of potential self-harm, identifying several reasons why the existing classifications are insufficient. One issue is that coroners and medical examiners do not have a uniform standard of proof for classifying a death as a suicide.
The current data suggests that opiate-related suicides have roughly doubled since 1999, while those considered accidental have increased four-fold:
The common narrative for a victim of the opioid crisis is that of a person suffering from addiction who accidentally overdoses, often on street drugs that are becoming increasingly more potent. But given the ambiguity that surrounds how overdoses are classified under the existing definitions of underlying causes of death, suicides may be an important focus in the national fight against this epidemic.
“I absolutely think that suicide that should be part of the conversation,” Brown says. “There needs to be increased focus on access to opioids as a potentially lethal method for suicide. It’s an area that many clinicians haven’t focused when evaluating suicide risk.”
VICE reporter Maia Szalavitz addressed this subject last year from the perspective of her own history of addiction. “The line between the intentional and unintentional is murky at best,” she wrote. “Many people who truly want to live (like me, even during my active addiction) sometimes take insanely high doses and mixtures.”
But, compounding one tragedy upon another, many addicts don’t want to live anymore.
“Determining whether people actually intend to die really matters,” Szalavitz wrote. “For one, many pain patients say they would kill themselves if they feared they were about to be cut off from their medications. If such deaths are counted as accidental overdoses, however, access to those same medications can get blamed incorrectly.”
As America faces this ballooning crisis, the evidence — or lack thereof — indicates that confronting the role of suicide could save more than 9% of the lives of future victims.
CDC WONDER. In accordance with CDC guidelines, accidental overdoses from opiates were gathered from ICD-10 codes X40-X44, intentional overdoses from codes X60–X64, assaults from code X85, and undetermined from codes Y10-Y14.