Links between suicidal intent, polysubstance use, and medical treatment after non-fatal opioid overdose. (1st July 2020)

• Record Type: Journal Article
• Authors: Gicquelais, Rachel E.; Jannausch, Mary; Bohnert, Amy S.B.; Thomas, Laura; Sen, Srijan; Fernandez, Anne C.
• Is Part Of: Drug and alcohol dependence. Volume 212(2020)
• Publication Date: 2020-07-01
• Subjects: overdose -- suicide -- opioids -- polysubstance use; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2020.108041
• Languages: English
• ISSNs: 0376-8716

Abstract

Graphical abstract: Highlights: Surveyed 274 people receiving addiction treatment about most recent opioid overdose. 7 % said they wanted to die and 44 % didn't care about the risks during last overdose. Active/passive intent at OD associated with recent suicide/self-harm thoughts. Active suicidal intent associated with hospitalization following opioid overdose. Overdose prevention should routinely assess and address suicide risk. Abstract: Background: Suicidal thinking during non-fatal overdose may elevate risk for future completed suicide or intentional overdose. Long-term outcomes following an intentional non-fatal overdose may be improved through specific intervention and prevention responses beyond those designed for unintentional overdoses, yet little research has assessed suicidal intent during overdoses or defined characteristics that differentiate these events from unintentional overdoses. Methods: Patients with a history of opioid overdose (n = 274) receiving residential addiction treatment in the Midwestern United States completed self-report surveys to classify their most recent opioid overdose as unintentional, actively suicidal (wanted to die), or passively suicidal (didn't care about the risks). We characterized correlates of intent using descriptive statistics and prevalence ratios. We also examined how intent related to thoughts of self-harm at the time of addiction treatment. Results: Of opioid overdoses, 51 % involved suicidal intent (44 % passive and 7 % active). Active suicidal intent was positively associated with hospitalization. Active/passive intent (vs. no intent, aPR: 2.2, 95 % CI: 1.4–3.5) and use of ≥5 substances (vs. 1 substance, aPR: 3.6, 95 % CI: 1.2–10.6) at the last opioid overdose were associated with having thoughts of self-harm or suicide in the 2 weeks before survey completion in adjusted models. Participants who reported active/passive intent more commonly used cocaine or crack (27 %) with opioids during their last overdose relative to unintentional overdoses (16 %). Conclusions: Over half of opioid overdoses among individuals in addiction treatment involved some degree of suicidal thinking. Identifying patients most at risk will facilitate better targeting of suicide prevention and monitoring services.