Prescription Opioid Abuse and Risks for Suicide

Prescription opioids are a group of medications commonly used to treat forms of pain that don’t respond to other types of medication-based treatment. Because of certain changes they make in normal brain function, these medications present a very real risk for both abusive patterns of use and drug addiction; in turn, both prescription opioid abuse and prescription opioid addiction create increased risks for suicidal thinking and active suicide attempts. According to research findings reported in 2012, elevated suicide-related risks commonly remain in long-term opioid abusers and addicts even when they discontinue drug use.

Prescription Opioid Basics

All prescription opioids are based on substances that occur naturally in Papaver somniferum, a plant species popularly known as the opium poppy. Two of these medications, morphine and codeine, come more or less directly from ingredients contained in the sap of P. somniferum. Two other common prescription opioids, hydrocodone (Vicodin, Lortab), and oxycodone (OxyContin), are created in pharmaceutical laboratories through chemical manipulation of naturally occurring opioid substances. Three additional common opioid medications—fentanyl (Fentora, Actiq), synthetic codeine, and meperidine (Demerol)—are manmade substances designed to chemically resemble the natural opioids.

Each prescription opioid medication has its specific typical role in medical treatment. For instance, doctors typically use codeine to relieve relatively moderate pain or ease the effects of medically serious coughing or diarrhea. Morphine is commonly used to relieve severe pain in surgical settings, while doctors use hydrocodone and oxycodone for a range of conditions involving moderate to severe pain. Regardless of their particular common use, all prescription opioids (and illegal opioid drugs) achieve their pain-relieving effects in a similar way by entering the body and attaching themselves to sites in the nervous system called opioid receptors. When activated by the presence of opioids, these receptors help override pain signals traveling through the nervous system to the brain.

When opioids attach themselves to opioid receptors located in the brain, they produce an additional effect by triggering a dramatic increase in the levels of a brain chemical called dopamine; in turn, this dopamine increase produces intense pleasure. In prescription users, opioid abuse and addiction typically become issues when a given individual seeks out this pleasure as a recreational activity and increases his or her level of intake above the level sanctioned by a doctor. This situation differs fundamentally from the situation of prescription users who follow their doctors’ orders and come to depend upon opioids’ legitimate pain-relieving effects.

Suicide-Related Risks

Unfortunately, suicidal thinking and active suicide attempts are found among prescription opioid abusers and addicts with some regularity. In 2012, researchers from the American Psychiatric Institute for Research and Education examined suicide-related factors in almost 38,000 participants in a study called the 2009 National Survey on Drug Use and Health, which was conducted by the U.S. government’s Substance Abuse and Mental Health Services Administration.

These researchers found that about 15 percent of the survey respondents had misused a prescription opioid medication at least once. They also found that roughly 11 percent of all people who had misused prescription opioids for at least two years had considered suicide in the year before the survey. In addition, roughly 9 percent of all people who had misused these medications for less than a year had considered suicide during the same period of time. By comparison, only 3 percent of people who didn’t use prescription opioids considered suicide in the year before the survey.

The authors of the American Psychiatric Institute for Research and Education’s study noted several factors that help determine the risks for suicidal thinking in people who misuse prescription opioids. The most prominent factor is a level of misuse that qualifies for standard definitions of drug abuse or drug addiction; fully 23 percent of survey participants with suicidal thoughts self-reported this degree of medication misuse. Another important factor is the presence of symptoms consistent with a diagnosis of the psychiatric disorder known as major depression. In addition, the authors of the study concluded that the risks for suicidal thinking don’t end with the discontinuation of opioid use, and former long-term users continued to exhibit suicidal thought patterns significantly more frequently than people who have never used prescription opioids.

About 18 percent of all current prescription opioid users/abusers who considered suicide actually went on to make active suicide attempts, while 7 percent of former users/abusers with suicidal thoughts attempted suicide. By comparison, 11 percent of survey participants with suicidal thoughts who never used a prescription opioid attempted to kill themselves.