Is Addiction or Undertreated Pain Causing Suicides? – April 27, 2018 – Pain News Network – By Pat Anson, Editor
A new op/ed in The New England Journal of Medicine focuses on an aspect of the overdose crisis that’s rarely discussed – how opioids are a “silent contributor” to the nation’s rising suicide rate.
But critics say the article misses the mark on why a growing number of pain patients are having suicidal thoughts and taking their own lives.
I’m glad this is receiving more attention (see Many Opioid Overdoses May Be Suicides), though it seems to be getting lost in the incessant roar of opiophobia.
“The significant increases in both opioid-overdose deaths and suicide rates in our country have contributed to reduced life expectancy for Americans.
These two epidemics are intermingled, and solutions to address the opioid crisis require that we tailor interventions to preventing opioid-overdose deaths due to suicidal intent,” wrote co-authors Maria Oquendo, MD, and Nora Volkow, MD.
Volkow is the longtime director of the National Institute on Drug Abuse, while Oquendo is a Professor of Psychiatry at the Perelman School of Medicine at the University of Pennsylvania and past president of the American Psychiatric Association.
Volkow and Oquendo believe many suicides are misreported as “undetermined” or accidental drug overdoses, and that “the true proportion of suicides among opioid-overdose deaths is somewhere between 20% and 30%, but it could be even higher.”
They also engage in a familiar pattern of demonizing opioid pain medication, citing studies showing that patients with “opioid use disorder” (OUD) from prescription opioids are more likely to have suicidal thoughts and…
Yet we know that addiction from prescribed opioids is less than 5%, so suicidal thoughts might arise from being treated as a person with addiction (having a “Substance Use Disorder”) instead of a person with chronic pain.
“whose motivation to live might be eroded by addiction.”
Substitute the word “addiction” with “pain” and this will be true.
The suicide rate among chronic pain patients is probably increasing.
But what’s puzzling is that Volkow and Oquendo never acknowledge the role that the federal government has played in contributing to that trend.
Anecdotal evidence is building that suicides started climbing after the CDC released its 2016 opioid prescribing guidelines and pain medication became harder to get.
Those suicides — such as those of Bryan Spece and Jay Lawrence — are rarely reported by the mainstream media or even acknowledged by government bureaucrats like Volkow, who was an early supporter of the CDC guidelines.
Patient advocates say these suicidal thoughts are often not the result of addiction or OUD, but because chronic pain is increasingly untreated or undertreated.
“The diagnosis of OUD is overwhelmingly made by physicians who are untrained in making the diagnosis,” says Stephen Nadeau, MD, a Professor of Neurology and Clinical Health Psychology at the University of Florida College of Medicine.
That’s why the latest DSM-5’s “continuous spectrum” approach of drug abuse is such a problem for pain patients. Only in the fine print after the qualifying traits does it continue and exempt patients who have been prescribed opioids for a legitimate condition.
In a quick read, that exemption can easily be missed, leading doctors to label anyone who takes opioids for any reason whatsoever to believe the patient “has an addiction”. See
Even worse, the DSM-5 seems to categorize chronic pain itself as a mental disorder:
- “Somatic Symptom Disorder” to replace more specific ICD billing codes
- Somatic Symptom Disorder – The DSM V debacle
“Most patients in chronic pain are under-dosed and/or suffer from inadequately treated depression. We don’t know the exact figures on prevalence of under-dosing but we do have studies that suggest that depression is detected only 20% of the time.”
“There is emerging data to suggest that increasing numbers of opioid overdose-related deaths may be a consequence of undertreatment of both pain and depression.
Yet the public narrative never mentions this. It seems only pain patients themselves and their loved ones really understand the devastating impact of chronic pain on someone’s life.
But the dominant public narrative is demanding even less treatment of pain when opioids are the chosen therapy,” says Red Lawhern, PhD, co-founder of the Alliance for the Treatment of Intractable Pain, a patient advocacy group
“Their article is seriously deficient for failure to mention that both substance abuse and suicide generally are closely associated with depression and isolation — both of which are consequences of economic hard times. It is simply wrong to imply that opioid use disorder (itself an incorrect term) is the ‘cause’ of suicide, when both are driven jointly by socio-economic factors,” Lawhern wrote in an email.