Are Fatal Overdoses a Form of Suicide?

The scientist who found the lifespan of older white males has been decreasing has a shocking opinion: Fatal drug overdoses are a form of suicide.

Angus Deaton, a professor of economics at Princeton University, told a congressional committee this month that many of the annual 60,000 drug overdose deaths that occurred last year are not just accidents, but forms of suicide where the opioids have become “an accelerant, a set of drugs that added fuel to the fire, and made an already bad situation much worse.”

“We tend to regard all of these deaths of despair as suicides in one form or another,” Deaton testified before Congress, “and we believe that suicides respond more to prolonged economic conditions than to short-term fluctuations and especially to the social dysfunctions, such as loss of meaning in the interconnected worlds of work and family life, that come with prolonged economic distress.”

In a research paper released in March, Deaton and fellow Princeton professor Anne Case suggest that the increases in deaths of despair are accompanied by a measurable deterioration in economic and social well-being. They found that part of reason for the drug epidemic is that marriage rates and labor force participation rates have fallen from generation to generation, while reports of physical pain, and poor health, and mental health problems rise.

“[But] purely economic accounts of suicide have rarely been successful in explaining the phenomenon,” they wrote. “If they work at all, they work through their effects on family, on spiritual fulfillment, and on how people perceive meaning and satisfaction in their lives in a way that goes beyond material success. At the same time, increasing distress and the failure of life to turn out as expected is consistent with people compensating through other risky behaviors such as abuse of alcohol and drug use that predispose towards the outcomes.”

Dr. Maria Oquendo was blunter before Congress.

“Hidden behind the terrible epidemic of opioid overdose deaths looms the fact that many of these deaths are far from accidental. They are suicides,” said Oquendo, a former president of the American Psychiatric Association and chair of psychiatry at the Perelman School of Medicine at the University of Pennsylvania.

The number of drug overdose epidemic deaths in the United States passed the number of suicides in 2014 for the first time ever: 47,055 fatal overdoses, according to the U.S. Centers for Disease Control and Prevention, compared to 42,773 suicides. For the past decade, the number of fatal overdoses has more than doubled, going from about 30,000 in 2005 to an estimated 60,000 last year.

Over the same period, the mortality rate of white non-Hispanics aged 50 to 54 with only a high school degree exploded, Deaton and Case of Princeton found. In 1999, the mortality rate was 30 percent lower than the mortality rate of blacks in the same age group but irrespective of education; by 2015, it was 30 percent higher.

“Whether the cause of overdose deaths is suicide or an accidental death or they don’t care or are trying to escape, the frame of what is the cause of these deaths is part of a bigger question,” said Clay Marsh, a medical doctor and executive dean for health sciences at West Virginia University. “When you look at the group, they are dying of despair and hopelessness, and it is a real underlying problem and suicide has to be thought as one of the explanations as to why the overdoses are so high.”

Suicide is a well-documented risk among people with mental health disorders, and studies have also shown suicide is clearly linked with the disease of addiction. The three key signs of suicidal tendencies are substance abuse disorder, a diagnosable mental illness, and a history of depression.

The idea that many opioid overdoses are suicides and not accidental deaths is not just a recent interpretation. In 2011, Martin Cheatle, a psychiatrist researching drug addiction at the University of Pennsylvania, wrote for the National Institute on Drug Abuse that “risk factors for suicidal ideation are so high in this population that it must be assumed that some proportion of those who die of drug overdoses might have intended to end their lives, not just temporarily relieve their pain.”

“Part of the issue that we need to deal with is that the problems and prevention of suicides and the chronic diseases that bring about addiction are related and part of a deeper problem,” said Marsh.

Ian Rockett, an epidemiologist from WVU, has studied the causes of overdoses in West Virginia and Ohio, and found that 80 percent of the overdoses categorized as “accidental,” and 90 percent of the ones ruled as “undetermined,” had circumstances that could be more suicidal in nature. Rockett wants a new category added to the death certificates: Death from Drug Self-Intoxication (DDSI).

“What we are saying is that most of the causes of these drug deaths are from self-induced injuries,” Rockett said.

In the American Journal of Public Health (PDF), Rockett wrote that “suicide and other self-directed violence deaths are likely grossly underestimated, reflecting inappropriate classification of many drug intoxication deaths as accidents or unintentional… As the tide of prescription and illicit drug-poisoning deaths is rising, public health and research needs would be better satisfied by considering most of these deaths a result of self-intoxication. Epidemiologists and prevention scientists could design better intervention strategies by focusing on pre-morbid behavior.”

The same has been said of obesity, but that doesn’t make it like suicide, according to Keith Humphreys, professor of psychiatry and behavioral science at Stanford University.

“Something like 50 million Americans are overweight, and many eat food that is not good for them and will make them die,” Humphreys said. “That is not suicide. I think drug overdoses tend to be in the same category.”

Humphreys says the problem is that heroin users start out “feeling like their life is a five rating, and heroin makes them feel like 25. Over time, the addiction makes them feel like they are a negative five and the heroin gets them up to five. The addiction becomes less enjoyable and negative and not very appealing. But I don’t think the overdoses, for the most part, are suicides.”

“To the extent that people are feeling shitty and doing what they can to self-medicate through drugs and doing it in a very dangerous way, I agree that it is not an accident that many overdoses happen,” said Leo Beletsky, a professor of law and health sciences at Northeastern University. “Whether they are intentionally suicidal, I don’t know.

“I think that exploring the common root cause of both suicides and overdoses and acknowledging there is some overlap is important,” Beletsky continued. “What is behind these two interlinked crises? But it is clear what is happening. Our population is in distress and compartmentalized, and just saying it is this way can be combative.”