1
Prescription Drug Abuse &
Suicide
SAVING GENERATION RX:
PREVENTING PRESCRIPTION DRUG ABUSE IN EAST
TENNESSEE
SEPTEMBER 19TH, 2014
SAMANTHA NADLER, B.S.
TENNESSEE SUICIDE PREVENTION NETWORK
Facts About Suicide

39,518 people died by suicide in 2011 in the United States.

938 people died by suicide in 2011 in Tennessee.

Approximately 317,305 people had thoughts of suicide in Tennessee in
2011 (5% of population).

Over 1 million people attempt suicide each year, according to a
recent SAMHSA study.
CDC/AFSP/AAS
2
Facts About Suicide

Suicide was the 10th leading cause of death for all age groups
(2011).

Suicide was the 2nd leading cause of death of ages 10-24.

Someone dies by suicide approximately every 13.3 minutes.

Someone aged 10-24 dies by suicide approximately every 1.75
hours.
3
CDC/AAS
ESTIMATES ON ATTEMPTS
25 attempts for each
documented death
Gender and Suicide - 2011

Men are nearly 4 times more likely to die by suicide than women.

Women attempt suicide 3 times as often as men.

Gender Deaths Rate
♂
♀
31,003 20.2
8,515
5.6
5
MEANS OF SUICIDE - 2011
Tennessee United States
Firearms
64.9%
50.6%
Suffocation
18.6%
25.1%
Poisoning
12.9%
16.6%
All other means (cutting, jumping, etc.) are < 2%
Poisoning includes …
Overdose
Rx, OTC, & Street Drugs
Alcohol
Frequently Multiple Substances
Ingestion
of poisonous
compounds
Exposure to toxic fumes, etc.
7
Overdoses
 Up
8
to 75-90% of all intentional poisoning deaths
are by drugs or alcohol in the U.S.

At the same time, another study reports that
the average fatality rate for overdose is
estimated to be only 1.8%.

It is frequently challenging to separate
intentional from accidental .
Poisoning Deaths vs.
Motor Vehicle Traffic Deaths

In 2008, poisoning deaths exceeded MVT
deaths for the first times since at least 1980.
 Poisoning
 MVTs
deaths nearly tripled
are decreasing
 Poisoning
deaths caused by drugs increased from
60% to 90%.
9
Drug Poisoning Death Rates,
by Intent - USA, 1999-2009
10
Facts About Suicide
11
 People
with substance abuse (SA) disorders
are at elevated risk for suicidal ideation and
attempts.
 People
who have been treated for SA at 10
times greater risk to eventually die by
suicide than the general population.
Kelller, Borges, & Walters 1999
Prescription Drugs
Dependency & Suicide Risk

People dependent on certain kinds of
medications are at increased to die by
suicide as the general population:
 Opioid
Painkillers
= 14 times the risk
Morphine,
Hydrocodone,
Oxycodone
 Benzodiazepines
Ativan,
= 45 times the risk
Xanax, Librium, Klonopin,
Valium, Dalmane, Restoril, Halcion
12
Substance Abuse & Suicide

~30 percent of deaths by suicide
involved alcohol intoxication –
 Blood
Alcohol Content (BAC) at or
above legal limit (.08%)

~ 40-66 percent of people who die by
suicide have a positive BAC
13
The Triple Dynamics of Substance
Abuse and Suicide
1
- RISK FACTOR for suicide
2 - ACUTE Substance Use (Getting drunk or
high)
 Decreased
fear – (FEAR is protective)
 Pain, “Screwing it up!” , Disfigurement
 Decreased impulse control
3
– MEANS of Death
15
Prescription Drugs & Suicide
Rx
abuse Risk factor
Iatrogenic factor
Means of suicide
“Risk Factors” for Suicide are
…
16
Characteristics of a person that
make
it more likely that individuals will
consider, attempt, or die by
suicide.
Major Risk Factors for Suicide

Psychiatric disorder, esp. Mood Disorders
 90%
of the people who die by suicide
have a mental health diagnosis.

Substance –related Disorders
 Co-Occurring
Disorders

Prior suicidal behavior

Access to lethal means
17
Abuse of Prescription Drugs
 Significant
18
risk factor
 “Abuse"
is any use of a prescription drug
except as prescribed by a physician to treat
a medical condition.
Using
a higher doses than prescribed
Using
the medications of others,
Buy
Etc.
prescription drugs off the street
Iatrogenic factor

…“of a medical disorder caused by the diagnosis, manner, or
treatment of a physician.”

…“doctor caused sickness”

Examples:
19

Getting an infection at the hospital.

Adverse reactions to a medication.

Doctor allows the natural history of a disease to progress untreated.
Medications Have Been
“Linked” to Depression
and/or Suicide

Anti-Depressant Medications - SSRIs

Pain Killers

Opioid Analgesics

Anticonvulsants

Inteferon/Ribavirin Therapy

Etc.
20
Selective Serotonin Reuptake
Inhibitors (SSRI)

Prozac, Paxil, Lexapro, Luvox, Zoloft, etc.

Treatment for depression & anxiety disorders

2004 – FDA reviewed clinical trials with kids


 “Black Box Warning”

 Significant reduction in treatment for children.
Very unclear whether SSRIs affect adult suicidality
21
Selective Serotonin Reuptake
Inhibitors

Later research  only a small increase in suicidal risks
with SSRIs, but a much greater benefit to taking the
medication.

Depression carries it’s own risk for suicide.

Sadly, many who could have benefitted from treatment
did not get the treatment they needed.

Risk-benefit analysis needed.
22
Prescription Drugs as Means
of Suicide

75% of poisoning by alcohol and/or drug overdose

47% had no known substance abuse problem

~ 25% ingested two or more drugs.

~ 8% = ETOH & Rxs

~ 8% = OTC & Rxs

~ 69% Used 1 type of Drug

~ 6% Unknown
23
Suicide with Single Type
Substance Overdose

Prescription drugs = 79% of deaths due to drugs

Opioid (morphine, hydrocodone, oxycodone)

Benzodiazepines (Valium, Xanax, Librium, Klonipin)

Antidepressants (SSRIs, Tricyclics)

Over-the-counter = 10% (especially Acetaminophen)

Street drugs = 2%

ETOH = 1%

Other specified substances = 6 %
24
Take Action!!!



Participate in TSPN

Monthly meetings all over the state

Regional Resource Directories
Get training – It’s Free

Suicide Prevention

Postvention
Keep doing what you are doing
25
26
Are there any
questions?
This project is funded under27
an agreement with the State
Of Tennessee.
Contact Information
Tennessee Suicide Prevention Network
295 Plus Park Blvd., Ste. 201
Nashville TN 37217
615-297-1077–main line 615-269-5413-fax
Scott Ridgway, M.S.
Executive Director
sridgway@tspn.org
Samantha Nadler, B.S.
Middle Tennessee Regional Coordinator
snadler@tspn.org
Vladimir Enlow, M.T.S.
Executive Assistant
vladimir@tspn.org
28