Even mild opioid use disorder is linked to a significantly higher risk of suicide

An analysis of National Survey on Drug Use and Health (NSDUH) data showed that individuals with opioid use disorder have 1.88 to 4.17 times greater odds of having suicidal thoughts compared to individuals without the disorder. Their odds of making a suicide plan were 3.35 to 6.7 times higher, while their odds of attempting suicide were 2.8 to nearly 10 times higher. The paper was published in the Journal of Psychiatric Research.

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Opioids are a class of drugs that act on specific receptors in the brain and body to reduce pain and produce feelings of euphoria. They include natural, semi-synthetic, and synthetic substances such as morphine, heroin, and fentanyl. Opioids are commonly prescribed for pain management but carry a high risk of dependence and misuse. If this risk materializes, opioid users may develop opioid use disorder.

Opioid use disorder is a medical condition characterized by a problematic pattern of opioid use leading to significant impairment or distress. It involves symptoms such as cravings, loss of control over use, and continued use despite harmful consequences. Individuals with opioid use disorder often develop tolerance, meaning they need higher doses of the substance to achieve the same effect. They also experience withdrawal symptoms when opioid use is reduced or stopped.

The disorder negatively affects physical health, mental well-being, and social functioning. It is associated with an increased risk of overdose, which can be life-threatening. Importantly, studies indicate that around 20% to 30% of opioid overdose deaths are intentional, meaning they represent suicides.

Study author William H. Craft and his colleagues noted that healthcare practitioners might be overlooking suicide risks in mild or moderate opioid use disorder cases, primarily linking those risks only to severe cases. They conducted a study in which they explored the links between opioid use disorder severity and suicidality in a nationally representative U.S. dataset.

They analyzed data from the 2021–2023 National Survey on Drug Use and Health (NSDUH), a nationally representative survey of non-institutionalized civilians aged 12 and older. However, for this specific analysis, the researchers focused exclusively on adults aged 18 and older. The survey collects broad data on substance use and mental health, including opioid use, suicidal thoughts, plans, and suicide attempts.

Data used in this analysis came from 139,524 participants. The study authors analyzed data regarding opioid use disorder severity and suicidality, as well as various demographic characteristics.

Results showed that slightly less than 2% of the study participants had an opioid use disorder in the past year. Of these, 62.9% had mild disorder symptoms, 15.9% had moderate symptoms, and 21.2% had severe symptoms. Among individuals without opioid use disorder, 4.8% reported suicidal thoughts, 1.3% reported suicide plans, and 0.6% reported a suicide attempt in the past year. Among participants with mild opioid use disorder, these percentages jumped to 11.3%, 4.9%, and 1.9%, respectively.

Among those with moderate opioid use disorder, the percentages of individuals reporting suicidal thoughts, plans, and attempts in the past year were 12.0%, 8.4%, and 6.6%, respectively. Among those with severe opioid use disorder symptoms, the percentages were 25.2%, 12.9%, and 8.4%.

In other words, the odds of having suicidal thoughts were roughly 1.9 to 4.2 times greater in individuals with opioid use disorder compared to those without the disorder. Their odds of having a suicide plan were 3.35 to 6.7 times higher, while their odds of attempting suicide were 2.8 to nearly 10 times higher. Notably, the study found that the risk for a suicide attempt escalated dramatically in moderate cases and remained similarly high in severe cases, suggesting that dangerous behaviors can manifest earlier in the disorder’s progression than expected. Importantly, researchers verified that while co-occurring depression accounted for a portion of these risks, opioid use disorder remained independently linked to higher suicidality.

“These findings suggest OUD [opioid use disorder] of any severity is associated with markedly increased risk of suicidal thoughts, plans, and suicide attempts. This highlights a continued need to integrate suicide screening and prevention into OUD treatment and clinical settings where opioids are frequently prescribed, such as primary care,” the study authors concluded.

The study contributes vital knowledge about opioid use disorder. However, it should be noted that the cross-sectional design of the study does not allow causal inferences to be derived from the results. Additionally, data were based on self-reports, leaving room for recall bias and social desirability bias. The estimates are also likely conservative because of survivorship bias—people whose suicide attempts resulted in death could not be included—and because the survey excludes institutionalized populations, such as incarcerated or unhoused individuals, who often have higher rates of the disorder.

The paper, “Opioid use disorder of any severity is associated with increased suicidality,” was authored by William H. Craft, Keith Humphreys, Michael J. Ostacher, and Claudia B. Padula.