CDC Obscuring Rate Of Suicide Among Opioid Overdoses

Difficult To Measure Rate Of Suicide Among Deaths From Opioid Overdoses – Kaiser Health News – March 2018

Mady Ohlman was 22 on the evening some years ago when she stood in a friend’s bathroom looking down at the sink.

“I had set up a bunch of needles filled with heroin because I wanted to just do them back-to-back-to-back,” Ohlman recalled. She doesn’t remember how many she injected before collapsing, or how long she lay drugged-out on the floor.

She wanted to be dead, she said.  

At that point, said Ohlman, she’d been addicted to opioids — controlled by the drugs — for more than three years.

“And doing all these things you don’t want to do that are horrible — you know, selling my body, stealing from my mom, sleeping in my car,” Ohlman said. “How could I not be suicidal?”

For this young woman, whose weight had dropped to about 90 pounds, who was shooting heroin just to avoid feeling violently ill, suicide seemed a painless way out.

You realize getting clean would be a lot of work,” Ohlman said, her voice rising. “And you realize dying would be a lot less painful. You also feel like you’ll be doing everyone else a favor if you die.”

Ohlman, who has now been sober for more than four years, said many drug users hit the same point, when the disease and the pursuit of illegal drugs crushes their will to live. Ohlman is among at least 40 percent of active drug users who wrestle with depression, anxiety or another mental health issue that increases the risk of suicide.

Measuring Suicide Among Patients Addicted To Opioids

How about measuring suicides among patients with chronic pain?

The CDC has all these numbers, but can’t seem to give us the correct information we need to devise an effective response to the climbing rates of addiction.

Massachusetts, where Ohlman lives, began formally recognizing in May 2017 that some opioid overdose deaths are suicides.

Hurrah for Massachusetts! Now let’s hope more states will follow this example and recognize the suicides for what they really are: not accidental overdoses from prescription medication, but suicides from illicit drugs by people overwhelmed by hopelessness.

Eventually, maybe the CDC itself will start showing us some the critical numbers, instead of this artificial categorization by whether opioids are synthetic or not. That only serves to obscure the wide differences in use between prescriptions drugs and illicit drugs, which could both fall into either category.

This “synthetic or not” categorization hid the distinction between prescribed and illicit opioids so well that I can only assume it was deliberate… and this is exactly the kind of decision PROP would have been actively involved in.

The state confirmed only about 2 percent of all overdose deaths as suicides, but Dr. Monica Bharel, head of the Massachusetts Department of Public Health, said it’s difficult to determine a person’s true intent.

“For one thing, medical examiners use different criteria for whether suicide was involved or not,” Bharel said, and the “tremendous amount of stigma surrounding both overdose deaths and suicide sometimes makes it extremely challenging to piece everything together and figure out unintentional and intentional.”

Research on drug addiction and suicide suggests much higher numbers.

“[Based on the literature that’s available], it looks like it’s anywhere between 25 and 45 percent of deaths by overdose that may be actual suicides,” said Dr. Maria Oquendo, immediate past president of the American Psychiatric Association

Oquendo pointed to one study of overdoses from prescription opioids that found nearly 54 percent were unintentional. The rest were either suicide attempts or undetermined.

Several large studies show an increased risk of suicide among drug users addicted to opioids, especially women. In a study of about 5 million veterans, women were eight times as likely as others to be at risk for suicide, while men faced a twofold risk.

The opioid epidemic is occurring at the same time suicides have hit a 30-year high, but Oquendo said few doctors look for a connection.

“They are not monitoring it,” said Oquendo, who chairs the department of psychiatry at the University of Pennsylvania.

The alarming increase in suicide is what the CDC should be monitoring.

The CDC’s purpose and reason for existence is to monitor threats to the health of American citizens yet it is still focusing almost exclusively on prescription drugs, which aren’t usually the drugs that people are abusing or overdosing on.

Meanwhile, other agencies, showing a little more intelligent response, are stepping into the gap and counting such suicides on their own initiative – and with their own money.

“They are probably not assessing it in the kinds of depths they would need to prevent some of the deaths.”

That’s starting to change. A few hospitals in Boston, for example, aim to ask every patient admitted about substance use, as well as about whether they’ve considered hurting themselves.

“No one has answered the chicken and egg [problem],” said Dr. Kiame Mahaniah, a family physician who runs the Lynn Community Health Center in Lynn, Mass.

Is it that patients “have mental health issues that lead to addiction, or did a life of addiction then trigger mental health problems?”

With so little data to go on, “it’s so important to provide treatment that covers all those bases,” Mahaniah said.

‘Deaths Of Despair’

When doctors do look deeper into the reasons patients addicted to opioids become suicidal, some economists predict they’ll find deep reservoirs of depression and pain.

In a seminal paper published in 2015, Princeton economists Angus Deaton and Anne Case tracked falling marriage rates, the loss of stable middle-class jobs and rising rates of self-reported pain.

The authors say opioid overdoses, suicides and diseases related to alcoholism are all often “deaths of despair.”

Many economists agree on remedies for that deep malaise. Harvard economics professor David Cutler said solutions include a good education, a steady job that pays a decent wage, secure housing, food and health care.

I’m pretty sure those days are over for good. Everything is faster and “more” now, including our jobs.

Employees’ every move is monitored and they are expected to achieve constantly increasing “goals and objectives”, which are actually management demands, each quarter.

Some companies have a policy that If a worker is in the bottom 10% of productivity for his group, no matter how perfectly they do their work, they are let go and replaced with “fresh meat”.

“And also thinking about a sense of purpose in life,” Cutler said. “That is, even if one is doing well financially, is there a sense that one is contributing in a meaningful way?”

That’s a much more abstract question than most workers have the luxury to ponder. They are too busy working, raising kids, and trying to stay ahead of their bills.

Tackling Despair In The Addiction Community

How about despair in the “chronic pain” community?

“I know firsthand the sense of hopelessness that people can feel in the throes of addiction,” said Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center; he is in recovery for an addiction to alcohol.

He should come to my house and see the hopelessness of chronic pain patients. Facing lifelong disabling pain without relief is lifelong torture.

The National Suicide Prevention Lifeline is 800-273-8255.

Author: Martha Bebinger, WBUR: marthab@wbur.org, @mbebinger

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

Original article: Difficult To Measure Rate Of Suicide Among Deaths From Opioid Overdoses – Kaiser Health News