Addiction Policy Forum Blog

7 min read

Suicide might be a root cause of more opioid overdoses than we thought

By Mark Gold, MD on December 12, 2019

An “intentional” suicide attempt by fatal drug overdose refers to an individual seeking to overdose in order to end her life. This may sound straightforward enough. But the issue is much more nuanced, related to how we understand and respond to the opioid overdose epidemic. If all overdoses are considered “accidental” until proven otherwise, we may be missing higher rates of suicide and depression, and different approaches to prevention, identification, and treatment. 

How exactly can coroners and officials who write on death certificates determine whether someone “intentionally” wanted to die by overdose or “unintentionally” died by overdose, without any desire to die at all? The Directors of the National Institute of Mental Health (NIMH) and National Institute on Drug Abuse (NIDA) recently reviewed the literature linking overdose and suicide.1 Up to 30 percent of all accidental overdoses are actually suicides. They observed that, controlling for other conditions, suicidal thoughts are 40-50 percent higher among individuals misusing prescription opioids, and that, “people with a prescription opioid use disorder were also twice as likely to attempt suicide as individuals who did not misuse prescription opioids.”

In the U.S., suicide rates are increasing, overdoses are increasing, and life expectancy is decreasing—“deaths of despair”, they are often called. Between 1999 and 2009, opioid-related suicide rates doubled.2 Opioid-related overdose deaths among Americans and adolescents have also surged. And both opioid-related deaths and suicides have increased to epidemic levels in the United States. Doctors Nora D. Volkow and Maria A. Oquendo3 have written that declining motivation to live can range “from engagement in increasingly risky behaviors despite a lack of conscious suicidal intent to frank suicidal ideation and intent.” Most of what we used to think as leading causes of death have been decreasing. Deaths due to cardiovascular disease, cancer, stroke, and lung disease have all been steadily decreasing since 2000. But deaths from drugs, alcohol, and suicide have been increasing. Things have changed so much and so fast that more U.S. deaths now result from self-harm than even diabetes.4 Suicide is more than twice as common as homicide in the United States. Accidents, which may sometimes be covert suicide, make up the other leading causes of death. The major default manner-of-death assignment for injury cases contain misclassified suicides.5

Yet little attention has been paid to these deaths’ contributions to overdoses, suicide, and addiction.6 In a recent study, nationally recognized research leaders explore the connection between opioid-related overdoses and the spectrum of suicidal motivation.

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7 min read

How much social media is too much for teens?

By Mark Gold, MD on October 24, 2019

In August, the Substance Abuse and Mental Health Services Administration (SAMHSA) released results from the 2018 National Survey on Drug Use and Health. The release revealed that 14.4 percent of adolescents between the ages of 12 and 17 had a major depressive episode in the past year.1 Major depressive episodes are mental disorders characterized by two-week or longer periods of depressed mood or decreased enjoyment of usual activities, and associated behavioral problems. According to these released figures, 3.5 million, or one-in-seven adolescents had a major depressive episode in the past year. The numbers rose from 2017 when 13.3 percent of adolescents had experienced such an event and were up from 2004 when only 9 percent did. Added to rising suicide rates,2 these numbers raise the alarm of worsening mental health trends among adolescents. The internet and social media appear to play critical roles in spreading suicidal behavior: the effect of suicide clusters, for example, implicates social media.3  

While many young Americans face a dizzying array of challenges in their lives—from substance misuse to academic pressures to general fears about societal stability—adolescents in the past have also dealt with these concerns and did not experience a similar rate of depressive episodes. This leads journalists, educators, experts, and politicians looking for a root cause to understand these recent changes, and one major change stands apart from the rest: access to social media. In a recent study, researchers tried to determine whether frequent social media use contributes to negative mental health outcomes among adolescents.

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2 min read

Physical Activity May Reduce Risk of Depression

By Mark Gold, MD on March 14, 2019

As depression becomes a leading cause of disability worldwide, it is even more imperative to focus upon effective preventative measures. Findings from a recent study strengthen the empirical support, and provide the most compelling case yet, for physical activity as an effective prevention strategy for depression. Read further to find out more on how physical activity can influence risk of depression and how this can shape the future of depression prevention and treatment.

Exercise is known to be effective stress relief - higher levels of physical activity can potentially inhibit the risk of developing mental illness. As building evidence further fortifies this theory, a new study by the research team at Harvard Medical School, led by Karmel W. Choi, PhD, postdoctoral fellow at the Harvard T.H. Chan School of Public Health and Harvard Medical School’s Massachusetts General Hospital, has discovered that robust physical activity is an effective treatment for depression.

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