Between 2000 and 2017, unintentional deaths and suicides related to opioid use have increased substantially, whereas overall deaths from suicide and undetermined intent have decreased, according to study results published in JAMA.
The National Vital Statistics System mortality multiple cause-of-death data were used for this study to identify drug overdose deaths involving opioid analgesics in people ≥15 years of age. Investigators assessed trends in manner of death between 2000 and 2017 in individuals who used opioids. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes X40-44, X60-64, and Y10-Y14 were used to identify deaths of unintentional, suicide, or undetermined causes, respectively.
In 2017, the number of opioid-related deaths was 43,036 for unintentional deaths (90.6%; 95% CI, 90.3%-90.9%), 1884 for suicides (4.0%; 95% CI, 3.8%-4.1%), and 2586 for deaths of undetermined intent (5.4%; 95% CI, 5.2%-5.7%).
From 2000 to 2017, there was an increase in opioid-related deaths from 2.20 per 100,000 persons to 13.21 per 100,000 persons (trend, 9.19; 95% CI, 7.91-10.46) for unintentional deaths and from 0.27 per 100,000 persons to 0.58 per 100,000 persons (trend, 0.30; 95% CI, 0.21-0.38) for suicides. Suicide decedents were older (mean age, 51.7 vs 42.7 years), more often female (56.3% vs 34.9%), and white (89.1% vs 75.5%) compared with decedents of undetermined intent (all P <.001).
There were no significant trend in deaths of undetermined intent observed from 2000 to 2017 (from 0.51 to 0.79 per 100,000 persons, respectively; trend, 0.02; 95% CI, −0.08 to 0.13). Between 2000 and 2017, the proportion of unintentional opioid-related deaths increased from 73.8% to 90.6%, respectively (P <.001). Conversely, suicides decreased from 9.0% to 4.0%, and deaths of undetermined intent decreased from 17.2% to 5.4% (both P <.001).
According to the investigators, a limitation of the study was the possibility of changes in coroner or medical examiners’ determination of manner of death over time, which may have affected the validity of these data.
On the basis of their findings, the investigators concluded that studies like these “could inform suicide prevention efforts, especially considering the high risk of suicide following nonfatal opioid overdose.”
Olfson M, Rossen LM, Wall MM, Houry D, Blanco C. Trends in intentional and unintentional opioid overdose deaths in the United States, 2000-2017. JAMA. 2019;322(23):2340-2342.