A hidden epidemic in the opioid crisis

MSU Today

While studying ways to prevent suicide among recently released jail inmates, Michigan State University researcher Jennifer Johnson began to notice that a growing number of opioid overdoses were not accidental.

“Within the opioid epidemic, there may be a hidden suicide epidemic,” she said.

It is a crisis that Johnson, a C.S. Mott Endowed Professor of Public Health in the College of Human Medicine, will study under a $1 million supplemental grant from the National Institute of Mental Health.

The funding is in addition to a $6.8 million grant she and her co-author Lauren Weinstock received in 2016 for a broader study to identify ways of preventing those recently released from jail from taking their lives.

In the years since the initial grant was approved, opioid overdoses in the United States have spiked, prompting the U.S. Department of Health and Human Services to declare it a public health emergency. The number of deaths from opioid overdoses since 2000 has increased by 200 percent, to about 64,000 deaths per year, data shows.

Much of that increase was occurring as Johnson and Weinstock, associate professor of psychiatry and human behavior at Brown University, were beginning their four-year study known as the SPIRIT Trial, or Suicide Prevention Intervention for at-Risk Individuals in Transition. That study eventually will include some 800 recently released detainees from the Genesee County Jail in Flint and the Department of Corrections in Cranston, Rhode Island.

“In our sample, we were seeing a lot of overdoses, particularly from opioids,” Johnson said. “When we asked, our participants told us that many were not accidental.”

Those hospitalized for opioid overdoses often receive treatment only for the overdose, not for the underlying cause, and patients often don’t tell medical providers that the overdose wasn’t completely accidental, Johnson said.

She added that those in her study are more candid, often admitting they took the drug in an effort to kill themselves. The ready availability of opioids, whether through prescriptions or illegal street sales, is “like having a gun in the house,” Johnson said. “The suicidality is out there. Opioids make it easier to act on it.”

People recently released from jail are four times more likely to attempt suicide than those in jail, and Johnson also indicated that about 11 million people in this country are booked into jails every year. Most are quickly released back into the community, and they account for a significant number of U.S. suicides.

Many of the suicide attempts likely are due to distress over legal or personal problems, including a perceived inability to recover from drug addiction.

“Differentiating the underlying causes of overdose is important because that will dictate the proper treatment, whether for substance abuse, suicide prevention, or both,” Johnson said.