National Opioid & Substance Awareness Day |  September 13, 2022
Hosted by the Brigham and Women’s Hospital’s POPI and B-CORE Programs


Recognize Opioid Misuse. Recognize Suicide Risk. Help Save a Life.

If either you or a loved one are using opioids, take a screening. Screenings are a quick way to determine if you or someone you care about may need to reach out to a doctor or mental health professional for a full evaluation. Screenings are not diagnostic and should be followed by a full evaluation to determine diagnosis and type of intervention that is needed.

Identifying Opioid Misuse/Disorder

One validated screening instrument commonly used is The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), developed by the World Health Organization (WHO). The ASSIST assesses risk for a variety of substances, not just opioids. We have specifically adapted this tool so that it can be used not only as a screen for opioid misuse in oneself, but also in a loved one.

Scoring positive on any screening test is not synonymous with a diagnosis. A diagnosis can only be determined by a complete evaluation. It is recommended that anyone who either scores positive on a screening test or continues to have concerns about opioid misuse should follow up for an evaluation.


Identifying Suicide Risk

Twenty-five percent of people who die by suicide are misusing or dependent on alcohol or drugs. Screening patients with conditions for which opioids are prescribed for suicide risk is essential, especially those who have a psychiatric/substance use disorder, experience chronic pain, require a high dose, or lack social support.


People Who Misuse Opioids Are at Very High Risk of Suicide.

U.S. Veterans with opioid use disorder have a rate of suicide six times greater than the general population. Having an opioid use disorder more than doubled the risk of suicide in female Veterans, and increased the risk of suicide by 30% in male Veterans.

Data from the National Survey of Drug Use and Health found that people with prescription opioid use disorder had a 40% to 60% increased risk of suicidal ideation, even after controlling for overall health and psychiatric conditions. People who used opioids regularly are twice as likely to attempt suicide as those who do not report any opioid use. People who use opioids regularly are 75% more likely to make a suicide plan.

Most suicides in opioid-dependent persons are firearm suicides, not overdose suicides.

Possible Explanations for Increased Suicide Risk

There are a number of reasons why misuse of opioids is associated with an increased risk of suicide. One possible explanation is the disinhibition that comes with opioid use. Opioids, like alcohol, are known to have disinhibiting effects, which may increase the likelihood of acting on suicidal impulses. The association between higher opioid dose and suicide may be due to certain characteristics of the people who take higher opioid doses. For example, those on higher doses may have more pain (which is an independent risk factor for suicide), poorer sleep, greater hopelessness, and more frustration with the quality of their care. Moreover, if opioids are provided to those in pain, the prescription itself may increase access to a potentially lethal means of suicide in a group that is already known to have high rates of co-occurring psychiatric disorders.

There is a link between opioid dose and suicide in patients with pain, but it is not simply that an increase in access to opioids leads to an increase in intentional overdoses. Identifying suicide risk among those who have conditions for which opioids are prescribed is very important, as it may lead to diagnosing a co-occurring other psychiatric disorder.