Overdose deaths in young substance abusers: accidents or hidden suicides?

Of 1969 earlier adolescent psychiatric inpatients, 1792 (91%) were traced after a mean follow-up period of 15 years. Thirty-nine patients, 2.3% of the men and 2.0% of the women had died from drug overdoses. An additional 16 drug- and alcohol-related deaths had occurred. The overdose death rate increased significantly during the observation period. At the time of death, 28 (72%) of the 39 overdose cases received a diagnosis of opioid dependence, the rest had polysubstance dependence. Death was most often caused by opioids. Comparing the 39 overdose cases with 39 surviving controls and 35 suicides from the same patient population, we found that the suicide cases had more psychotic symptoms, suicidal ideation, learning difficulties and somatic disorders. The suicide cases received less follow-up treatment on discharge from hospital, did not enter specific drug treatment programs, and were the only ones to be discharged to the street. We found no significant differences between the overdose cases and their surviving controls. Both groups showed poor impulse control and risk-taking behavior more often than the suicide group. The study lends support to the hypothesis that the majority of overdose deaths in young drug addicts are accidental poisonings and not misclassified suicides.