Detecting Suicidality in Opioid Use Disorder Requires an Understanding of Intentional Opioid Overdose

Area of Science:

• Public Health
• Psychiatry
• Addiction Medicine

Background:

• The suicide rate from opioid overdoses has more than doubled since 2000.
• Intentional opioid overdoses are likely undercounted, highlighting a critical public health issue.
• Individuals with opioid use disorder (OUD) face unique risks including psychiatric comorbidities, chronic pain, and negative emotional states.

Purpose of the Study:

• To emphasize the urgent need for a sensitive and validated assessment to identify individuals at risk for intentional opioid overdose.
• To discuss the affective, cognitive, and behavioral factors contributing to intentional opioid overdose.
• To advocate for the development of a specialized screening tool for intentional opioid overdose risk.

Main Methods:

• This commentary synthesizes existing research on opioid overdose, suicide risk, and the specific challenges in identifying intentional overdoses.
• It analyzes the limitations of current suicide risk screening tools in the context of opioid use disorder (OUD).
• It highlights the need for validated psychometric methods in developing new assessment tools.

Main Results:

• Higher prevalences of psychiatric diagnoses and pain are noted in the OUD population.
• Chronic opioid use can lead to a deleterious negative emotional state.
• The illicit opioid supply, including fentanyl, provides easy access to lethal means for suicide among individuals with OUD.

Conclusions:

• Validated screening tools for general suicide risk are insufficient for detecting intentional opioid overdose risk.
• The ambiguous intent preceding opioid overdoses makes them difficult to identify as suicide attempts.
• A specifically developed screening tool using validated psychometric methods is necessary to address intentional opioid overdose morbidity and mortality.