opioid use disorder and suicide risk use...david j. berman, mph, mpa vice president, mental health...
TRANSCRIPT
OPIOID USE DISORDER AND SUICIDE RISK
An estimated 43.8 million adults aged 18 and older in the United States have a diagnosed mental illness, and 17.5 million have an SMI (8% of total population)
An estimated 24.6 million Americans aged and older need treatment for substance use
1210
The total estimated annual cost for mental health and substance use treatment in the United States is $280 billion
Untreated MHDs and SUDs in the United States have an estimated annual economic impact of $650 billion in costs related to crime, lost or reduced productivity, and increased healthcare expenses
As of today, Depression has surpassed all physical diseases
as the major cause of disability worldwide.
Toxic stress and traumatic
experiences have been linked to
mental illnesses such as anxiety
disorders and depression, as
well as the exacerbation of other
existing mental health disorders.
In a critical event, 30-40% of
the impacted population will
likely have a new incident
based mental health disorder.
• Economic stress
• Social isolation
• Decreased access to systems of support
• Political and social outcomes
• Barriers to treatment
External Influencers During the COVID-19 Pandemic…
The Sacramento Bee: March 27, 2020
National increase in
suicide prevention hotline call volume was
300%
40% increase in messages
to Crisis Text Line
SAMHSA National
Helpline calls increased five-fold
Compared to 2018, in
April 2020, adults were
three times more likely
to fit criteria for
moderate or serious
mental distress (70.4%
vs. 22.0%).
https://time.com/5833619/mental-health-coronavirus/
America’s Mental Health Pulse Survey: Harris Poll – April 2020
37% of adults in the US report symptoms of severe anxiety
Nearly 29% of adults in the US report symptoms of depression
CDC Household Pulse Survey: November 15 – 21, 2020
Indiana Screening Data 2020
81,755
Total Indiana Screenings: Jan 2015 – Nov 2020
Age of Individual Completing Screening (2015 - 2020)
27.74%
30.72%
21.23%
10.46%
5.80%
3.15%0.91%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
11 - 17 18 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65 +
62,38176.12%
Positive or Moderate to Severe
23.88%%Negative or
Minimal to Mild
Screen Result Severity (2015 - 2020)
Total Screenings Comparison
2015 - 2020 April 2020 – Nov 2020
27,269 (33% of total)81,755
0
5,000
10,000
15,000
20,000
2020 2019
8,747
1,761
2,143
414
4,767
790
Depression Bipolar Disorder Anxiety
Positive or Moderate to Severe Screening:8 Month Comparison (April to November)
428% increase
4:52:20 PM
Every 28 seconds in the U.S....... there is a suicide attempt
(nearly 3,100/day)
16.1
10.7
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IndianaUSA
Slide created by CW Drapeau (2020)
Crude Suicide Rates, Indiana and USA, 1968-2018
Indiana: 51% increase9%
Early detection saves lives!
OPIOID USE SUICIDEOPIOID USE
AND SUICIDE
The United States has nearly 5 times the rate of death from drug overdoses as other comparable countries (including the UK, Canada, Australia, Austria, France, and Switzerland)
According to the CDC, opioids were involved in
more than 69,000 overdose deaths in 2019 (two-thirds of
all drug overdose deaths).
An estimated 30-40% of opioid overdose deaths are
likely suicides.
N Engl J Med. 2018 Apr 26;378(17):1567-1569
It is often difficult to assess the intentions of an individual who has died of an overdose, other than circumstantially…unless…
• Note
• Conversation
• Social Media Post
In a 2019 joint study between Harvard University and McLean
Hospital examining individuals who had recently overdosed on
opioids, nearly 60% of participants said that on some level, they
had at least some desire to die before their most recent
overdose, with 36% having a strong desire to die.
Connery, H.S., Taghian, N., Kim, J., Griffin, M., Rockett, I.R.H., Weiss, R.D., Kathryn McHugh, R. (2019). Suicidal motivations reported by opioid overdose survivors: A cross-sectional study of adults with opioid use disorder. Drug and Alcohol Dependence
Opioid use is associated with an increased likelihood of:
• 40-60% for suicidal ideation
• 75% for suicide attempt
• 1300% for death by suicide
J Psychiatr Res. 2017 Sep;92:1-7. doi: 10.1016/j.jpsychires.2017.03.011. Epub 2017 Mar 19.
• Individuals with OUDs often live on a continuum between wanting to live to wanting to die
• Feelings can waver
Walking a tightrope...
Individuals suffering from chronic
pain are at an increased risk of
suicide simply because of their pain
While there is limited research on the
effectiveness of strategies to prevent suicide
among individuals with chronic pain, there is
strong evidence to support comprehensive
suicide risk screening and assessment as a
means of identifying those at risk.
Traditionally, suicide and overdose
prevention in OUD involves stratifying
risk based on certain demographic and
clinical factors – however, this fails to
capture the full picture.
• The presence of acute withdrawal or craving
• Changes in patterns of opioid use
• Loss of identity, sense of belonging, or social supports; shame; humiliation; insomnia
• Increased use of other substances
• Recent personal or situational events, such as legal problems, or relationship conflict
Maruti S, Desjardins I, Bagge CL, Althoff RR. Commentary: opioid use disorder and suicide: an important opportunity to address two significant public health epidemics [published online October 21, 2019]. Prev Med. doi:10.1016/j.ypmed.2019.105854
Several decades of research show that
MAT accompanied by counseling can
reduce opioid overdose-related suicides.
• Opioid related suicide can still occur even when at-risk persons receive MAT
• Risk of death among those receiving MAT are highest when the medication is initiated and when the treatment is suddenly stopped
• Prevention efforts should involve addressing these critical transition periods
Clinical level prevention strategies include conducting comprehensive suicide risk screening and assessment
Provision of appropriate treatment
N Engl J Med 2019; 380:71-79 DOI: 10.1056/NEJMra1802148
• Educating medical providers on safe prescribing practices
• Increasing public awareness of non-medication strategies to address pain, and subsequently identifying and implementing appropriate strategies
• Hospitalization, if needed
Other clinical level prevention strategies:
Preventing Opioid Abuse, Overdose, and Suicide in Chronic Pain Patients: CAPT; SPRC; SAHMSA
• Increased access to treatment
• Comprehensive case management
• Vocational rehabilitation
• Legal and housing assistance
Community level prevention strategies:
Preventing Opioid Abuse, Overdose, and Suicide in Chronic Pain Patients: CAPT; SPRC; SAHMSA
On all levels, follow-up is a key component of
prevention.
...if you feel overwhelmed, stressed, or frustrated.
David J. Berman, MPH, MPAVice President, Mental Health America of IndianaExecutive Director, Indiana Suicide Prevention NetworkDirector, Depression and Bipolar Support Alliance of IndianaState Program Manager, Indiana Crisis Counseling Program
@DJBerman
/david-j-berman/