In the United States, deaths due to suicide and unintentional overdose pose a major, and growing, public health concern. The combined number of deaths among Americans from suicide and unintentional overdose increased from 41,364 in 2000 to 110,749 in 2017 and has exceeded the number of deaths from diabetes since 2010.1 The increase represents more than a doubling in the age-adjusted rate of deaths from suicide and unintentional overdose (Table 1), according to data from national surveillance systems.2 Accordingly, both suicide and unintentional overdose have been the focus of large-scale prevention efforts, such as the National Strategy for Suicide Prevention3 and the State Targeted Response to the Opioid Crisis grant program of the Substance Abuse and Mental Health Services Administration. Both problems have connections with pain and opioid use.4-8 The use of potentially lethal drugs such as opioids has a clear, direct relationship to the risk of unintentional overdose. Perhaps less well known, opioids also are linked to suicide risk.9 Furthermore, opioid use disorders have a distinctly strong relationship with suicide as compared with other substance use disorders.10 In all, more than 40% of suicide and overdose deaths in 2017 were known to involve opioids (Table 1), with many more likely to have had unrecorded opioid involvement. The common theme of opioid use underlying suicide and overdose poses questions of how these problems may be related to one another.6 This review describes what is known about the links between suicide and overdoses, with a focus on pathways through opioid use, issues of intent, risk factors, prevention strategies, and unresolved issues...
Language: en
LA - en SN - 0028-4793 UR - http://dx.doi.org/10.1056/NEJMra1802148 ID - ref1 ER -