Suicides by drug overdose have increased among teens, young adults and seniors, even as they declined for the overall population, U.S. federal researchers say.
Drug-related suicides declined for Americans in general during the latter part of the 2010s, researchers from the U.S. National Institute on Drug Abuse (NIDA) found.
But rates of suicide by overdose among 15- to 24-year-olds rose, as did those for 75- to 84-year-olds. These deaths fall into the same pattern of "deaths of despair" also linked to accidental overdoses and suicide by other means, said study co-author and NIDA director Dr. Nora Volkow.
"Both of them are likely driven by the same isolation and lack of mission," she said.
The study only looked at drug-related overdoses between 1999 and 2019, but Volkow said it's likely the COVID-19 pandemic has added to the problem.
"It's likely that the numbers will be worse, perhaps, during the pandemic," Volkow said.
Nadine Koslow, a professor of psychiatry and behavioral sciences at Emory University School of Medicine in Atlanta, agreed.
"As this pandemic goes on longer and longer, we're going to see more of that," said Koslow. "In general, we need to be concerned about these deaths of despair."
For this study, NIDA researchers analyzed data from death records, looking for drug overdose deaths that occurred as a result of suicide.
About 5% to 7% of overdose deaths are recorded as intentional, although Volkow said the number is probably higher, because not all suicide victims leave a note or other indication that they intended to kill themselves.
The suicide rate increased among 15- to 24-year-old males from 0.6 deaths per 100,000 in 2015 to 0.8 in 2019. It rose among females in that age group from 0.6 in 2014 to 1 in 100,000 by 2019.
"Young people are in a vulnerable age range, where their brains are still developing and factors like executive function and control are not in place yet. This can affect impulsivity and coping," said Dr. Smita Das, chair of the American Psychiatric Association's Council on Addiction Psychiatry. "They often also don't access health care enough by virtue of being healthy otherwise."
It's also an age of profound change, and Koslow noted that some young adults have trouble handling the shifting sands beneath their feet.
"This is the age when you're trying to figure out if you're going to be in college, if you're going to get a job, when you're going to leave home. It's a highly vulnerable group, and the stress of all this clearly has impacted them," Koslow said.
The same holds true in some ways for seniors, for whom overdose suicide rates went up even more, essentially doubling.
The rate of suicides by drug overdose rose among 75- to 84-year-old men from 0.7 per 100,000 in 2001 to 1.6 in 2019. The rate among women in that age group went up from 0.8 per 100,000 in 2001 to 1.7 in 2019.
"I think the 75- to 84-year-old group of people are like, OK, I'm not working anymore, what am I going to do with my life, my health is starting to fail? This is going wrong, that's going wrong. Really, what's meaningful in my life and what do I have next to look forward to?" Koslow said. "I think that group is particularly vulnerable."
There also was a concerning uptick in drug overdose suicides among Black women, rising from 0.4 per 100,000 in 2013 to 0.7 in 2019.
Koslow said she was "particularly shocked" to see the increase in intentional overdoses among Black women.
"There has been some evidence of death by suicide rates going up in the African American community, but this group of Black women has been historically very protected and had quite low rates because of strong family ties and strong religious beliefs," Koslow said. "This has been historically a very low risk group. So I think it's concerning to see that's not so clearly the truth anymore."
Screening for signs of anxiety, depression and suicidal thoughts should become a regular part of health care for teens and young adults, Volkow said.
"When children or adolescents go to the doctor, this should be part of the process, and if there is evidence of symptoms suggestible of mental disorders, you should actually do an intervention," Volkow said, adding that parents also should be taught to look for signs of distress in their kids.
Outreach to seniors is also needed, to help them deal with the changes that occur in their lives following retirement, Koslow said.
"If I got as many pieces of paper that told me how to cope with that stage of my life as I do about my choice of Medicare policy, it would be really wonderful," she said. "As you're thinking about retiring, you need help figuring out what you're going to do that matters in life. I think we don't do that at all. We just don't help people prepare."
The new study was published Feb. 2 in the American Journal of Psychiatry.
If you or someone you know is in crisis and needs immediate help, call the National Suicide Prevention Lifeline at 800-273-TALK (8255).
The National Suicide Prevention Lifeline has more about ways you can help someone at risk for self-harm.
SOURCES: Nora Volkow, MD, director, U.S. National Institute on Drug Abuse, Bethesda, Md.; Nadine Koslow, PhD, professor, psychiatry and behavioral sciences, Emory University School of Medicine, Atlanta; Smita Das, MD, PhD, MPH, chairwoman, American Psychiatric Association Council on Addiction Psychiatry; American Journal of Psychiatry, Feb. 2, 2022