Recognize Opioid Misuse. Recognize Suicide Risk. Help Save a Life.
Screening for 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.
WHY IS SUICIDE INCLUDED ON THIS SITE?
U.S. Veterans with opiate 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. Regular users 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. Screening for suicide risk among those who have conditions for which opiates are prescribed is very important, as screening may lead to diagnosing a co-occurring other psychiatric disorder.
SCREENING FOR SUICIDE RISK
Twenty-five percent of people who die by suicide are misusing or dependent on alcohol or drugs. Screening for suicide risk in patients with conditions for which opiates are prescribed is essential, especially those who have a psychiatric/substance use disorder, experience chronic pain, require a high dose, or lack social support.
Columbia-Suicide Severity Rating Scale (C-SSRS)
One screening instrument in widespread use is the Columbia-Suicide Severity Rating Scale (C-SSRS). The C-SSRS helps to identify whether someone is at risk for suicide. It was developed by researchers at Columbia University, the University of Pennsylvania, the University of Pittsburgh and New York University, with funding from the National Institute of Mental Health. The C-SSRS rates the degree of suicidal ideation on a scale, ranging from “wish to be dead” to “active suicidal ideation with specific plan and intent and behaviors.” An individual exhibiting even a single behavior identified by the scale was 8 to 10 times more likely to commit suicide. In 2012, the Food and Drug Administration declared the C-SSRS the gold standard for measuring suicidal ideation and behavior in clinical trials.
Family members, friends, neighbors, or colleagues can use the Community Card version of the C-SSRS. It involves asking between three and six questions. The answers provide enough information to determine whether the person you are concerned about is in need of help and/or immediate action. Anyone answering any of the 6 questions “yes” for themselves or on behalf of a loved one should contact the National Suicide Prevention Lifeline, a healthcare provider, or call 911.