By Lauren Smith
Updated: 09 March 2023 & medically reviewed by Dr. Kimberly Langdon
People who use medical opioids without a doctor’s prescription are 37% more likely to plan suicide, while the risk is even higher among people with disabilities who misuse opioids: they’re 73% more likely to attempt suicide, a new study has found.
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Disability and opioid use have already been separately linked to suicide
The findings, published in the journal Substance Use and Misuse, drew on the responses of more than 38,000 adults to the US National Survey on Drug Use and Health in 2019.
Previous studies have confirmed the multi-faceted link between opioid misuse and suicide, as narcotics give people access to lethal means, increase depression, reduce inhibitions, and contribute to other risk factors for suicide including family, legal, and financial difficulties. Prescription and non-prescription opiates are present in a fifth of suicide deaths in the US, and many other deaths that are classified as overdoses may be at least partially intentional.[2, 3]
Additionally, numerous studies point to an elevated risk of suicide among people with disabilities. One population-level study found that people with disabilities were four times as likely to attempt suicide, even when the data is adjusted for demographic factors.
People with disabilities are also more likely to misuse prescription opiates. They’re more likely to be prescribed opiates at some point and may begin excessively using the medication to ease unmanaged pain or mental health conditions worsened by disability.
Among Medicare recipients with disabilities, 43.7% use any opioids, while 23.1% use them chronically. While often these drugs are prescribed, safe use can quickly spiral out of control. Disabled Medicare beneficiaries are one of the fastest-growing groups hospitalized for opioid or heroin overdoses. And one study found that disability increases the risk of opioid misuse and opiate use disorder by 31% to 54%.
First study of suicidality among patients with disabilities who misuse opioids
However, this is the first study to explore the connection between opioid misuse and suicidality for people with disabilities.
The research found that of the 38,000 respondents to the National Survey on Drug Use and Health, 3.6% reported they had misused prescription opioids over the previous year, defined as any use of the drugs not directed by a doctor. Twice as many people with disabilities (6%) reported opioid misuse than people without disabilities (3%).
Those who misused opioids were also more likely to have had serious thoughts of suicide, planned suicide, or to have made a suicide attempt over the last year, confirming previous research.
Drug users with disabilities had even higher rates: 12.6% reported suicidal thoughts, compared to 4.2% of opioid abusers without disabilities. 5.5% had made a suicide plan, compared to 1.3% and 3.9% had made a suicide attempt in the previous year, compared to 0.8%. The elevated risk remained even when factors including mental health, other substance use, self-evaluation of physical health, and access to healthcare were taken into account.
“Suicide can be understood as a severe expression of psychological distress, and people with disabilities are likely under-identified and under-treated for mental health issues which may result in increased risks for suicidality, especially in the context of the opioid epidemic,” said the study’s lead author Keith Chan, assistant professor at the Silberman School of Social Work at Hunter College, New York.
People with disabilities are less likely to be treated for drug use
People with disabilities are also less likely to receive treatment for opioid use. Barriers to treatment include a lack of accessible entrances at addiction treatment facilities, inadequate insurance coverage, and the lack of non-opioid chronic pain management methods.
"Many people with disabilities have real and ongoing needs to manage pain, and more research is needed to identify alternatives that can be effective while addressing mental health for this population,” Chan said.
“We recommend that health care professionals who work with people with disabilities take into account the risks of suicide for those with a history of prescription opioid misuse. There is a need for effective mental health services tailored for people with disabilities to address the impact of the opioid epidemic,” he added.
"Health workers can serve as a nexus point in effectively engaging at-risk people with disabilities in substance use and mental health prevention and recovery services," said co-author Christina Marsack-Topolewski, assistant professor at the School of Social Work at Eastern Michigan University.