Suicide is a leading cause of death globally, and people who use drugs are at heightened risk.
Key facts:
- People who use opioids have 7-22 times the risk of suicide compared to the general population.
- Men who use drugs die by suicide more often, but women who use drugs have a higher proportional increase in risk compared to women without drug use disorders.
- Mental health conditions like depression increase suicide risk, especially when care is fragmented.
- Periods of instability like incarceration or initiating/stopping treatment are high-risk times.
- Violent suicide methods are more common with stimulant and cannabis use.
Source: BMC Psychiatry 2023
A new scoping review explored the evidence on risk factors for suicide in people who use drugs (PWUD), to inform prevention policies and help save lives.
The review suggests PWUD have distinct risks that suicide prevention efforts should consider.
About Suicide Risk in Drug Users & Addicts
Many complex factors contribute to suicide risk.
For PWUD, research indicates their risk of dying by suicide is 7-22 times higher than the general population.
Understanding key factors can help target prevention for this group.
The review gathered evidence from over 50 primary studies, reports and reviews published since 2000.
Most research came from Europe and Australia and focused on opioids, likely due to available data from treatment programs.
Sex Differences
Overall, men who use drugs die by suicide more often than women, mirroring global patterns.
However, several studies found a higher proportional increase in female PWUD’s suicide risk compared to men.
High rates of mental illness and barriers to accessing opioid addiction treatment may contribute.
Understanding men and women’s differing risks is key for prevention.
Psychiatric Conditions & Mental Illness
Comorbid mental illness clearly increases PWUD’s suicide risk.
Depression especially is highly prevalent, affecting up to 65% of people who died by suicide while using opioids.
Psychotic disorders also increase risk, sometimes exacerbated by poor medication compliance.
Dual diagnosis remains a barrier to accessing appropriate mental healthcare.
Integrating addiction and mental health services is critical.
Periods of Instability
For PWUD, periods of instability like incarceration, initiating/stopping treatment, and losing contact with healthcare providers marked heightened suicide risk.
Incarcerated women were especially vulnerable soon after imprisonment.
Maintaining stability and social connection may help mitigate risk during transitions.
Age Differences
A younger age profile among PWUD emerged as a risk factor in several studies.
PWUD in their teens and twenties showed the highest suicide rates in Europe.
However, risks may persist across age groups, as older adults with opioid disorders also showed elevated risk.
Tailoring support to life stage may help.
Effect of Drug Type
While opioids were most associated with suicide overall, patterns differed by drug type.
Stimulants and cannabis were linked to more violent suicide methods like hanging.
This suggests different suicide risks and prevention needs depending on substances used.
Considerations for Policy and Practice
The review highlights opportunities to strengthen suicide prevention in PWUD:
- Prioritize research on risk factors. Most existing studies lacked in-depth analysis. Prospective research can clarify risks.
- Look beyond opioids. Expand evidence on effects of rising drugs like cannabis and stimulants.
- Take a holistic view. Consider how systemic issues like racism and access to harm reduction shape risk.
- Tailor support. Address drug-specific risks and gender differences. Maintain care during transitions.
- Integrate care. Bridge divides between mental healthcare and addiction treatment.
With thoughtful policies and practices informed by emerging evidence, we can make progress in preventing suicide in this vulnerable group of people.
Understanding risk factors creates an opportunity to save lives.
References
- Study: Factors associated with suicide in people who use drugs: a scoping review
- Authors: Joan Devin et al. (2023)
