Drug overdoses muddy waters for investigators, amplify national mental health crisis
Times West VirginianFeb 13, 2021
Feb. 13—MORGANTOWN — Classifying a death as suicide may be easiest for medical examiners and coroners in the western
By contrast, suicides by drug overdose, spurred primarily by the opioid epidemic in the remainder of the country, are less obvious to investigators.
But a new
"Broadening the definition of SIM to encompass most drug overdose deaths, even if they don't meet the standards used by medical examiners and coroners to classify them as suicides, shows the whole nation is afflicted by a mental health crisis," Rockett said. "On the other hand, if we only represent SIM by registered suicides, this crisis misleadingly appears concentrated in western states."
Rockett, also adjunct professor in the
"Suicides likely have been easiest to detect in the west because the leading method is shooting and it is highly lethal," he said. "The remainder of the country has been more severely affected by the opioid epidemic through the opening decades of the 21st century. Our previous research indicating substantial overlap with a more hidden suicide epidemic, led me to develop SIM in collaboration with a very talented group of multidisciplinary researchers and practitioners about six or seven years ago. That the suicide epidemic was most pronounced in the west and the opioid epidemic elsewhere in the nation —
The findings appear in
The research team tapped into cause-of-death data for all 50 states and
After broadening the SIM definition, they found the national annual average percentage change in the SIM rate was 4.3% versus 1.8% for the suicide rate. By 2017-2018, all states except
"Despite victims sharing many common risk factors, suicide and drug overdose deaths tend to be treated separately in the scientific literature, media, health care system, and by funding agencies and prevention programs," Rockett said. "Among these risk factors are unemployment, family discord, unmanaged and mismanaged physical pain, and various psychiatric disorders that include alcohol and other substance use disorders.
"While most people dying by overdose may not have intended to die, they were engaging in repetitive, intentional, self-injurious behaviors that they understood markedly increased their chances of dying prematurely. Calling these deaths 'accidents' (the forensic classification most often used in the
Early data indicate the COVID-19 pandemic is making the national mental health crisis worse.
"Opioid and other drug-overdose deaths continue to rise in spite of medical efforts to make life-saving medications for opioid use disorder available to patients and communities," said co-author
Another of Rockett's co-investigators,
"Ultimately it is less about 'classifying suicide' and more about understanding that suicide and overdose fatalities reflect common social and psychological risk factors that were present long before death," Caine said.
"There are large groups of persons in our country who have suffered adverse early life experiences, family and social turmoil, economic hardships and life disappoints, as well chronic ailments; many die prematurely. Our goal must be to eliminate or mitigate those circumstances. Separating these groups using misclassified or misleading postmortem labels does little to enhance prevention. We need to focus on the lives of persons in these groups long before they get close to dying if we aspire to overcome these tragic losses of life."
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