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NEJM Article Highlights Links Between Opioid Use and Suicide

March 27, 2020

Takeaway: Within the context of the nation’s response to the crises of suicide and opioid use, including VA’s Opioid Safety Initiative, VA researchers developed a conceptual framework to understand risk for both suicide and overdose together. The New England Journal of Medicine features this HSR&D research showing links between opioid use, overdoses, and suicides.

The combined number of deaths among Americans from suicide and unintentional overdose increased from 41,364 in 2000 to 110,749 in 2017 and has exceeded the number of deaths from diabetes since 2010. In all, more than 40% of suicide and overdose deaths in 2017 were known to involve opioids, with many more likely to have had unrecorded opioid involvement. HSR&D research is contributing to the nation’s response to the crises of suicide and opioid use. VA research published in NEJM describes the links between opioid use, overdose, and suicide. Researchers developed a conceptual framework to understand the shared risk for suicide and overdose together and approaches that can be used to prevent both problems. This review synthesizes prior research on opioid use access, socioeconomic factors, issues of intent, and risk factors to understand why rates of these two causes of death are increasing in tandem in the U.S. while rates of most other leading causes of death are decreasing. More than 40% of suicide and overdose deaths in 2017 were known to involve opioids. Many factors promote the initiation and persistence of opioid use, but several specific pathways increase vulnerability to overdose and suicide, including:

  • Pain and risk of suicide and overdose;
  • Medical system drivers of opioid prescribing, increasingly used to treat chronic pain; and
  • Large-scale supply and demand.

This review further describes prevention strategies that address both suicide and overdose and recommends that these be the focus of program and policy initiatives.

VA is working on several fronts to combat the opioid crisis and to enhance suicide prevention and these efforts were highlighted in the review. For example, VA leaders developed a risk score for both suicide and overdose together (CRISTAL Report) that is available nationally through the Program Evaluation Center (PEC) Portal ( --- Intranet only, if you have inranet access, copy and paste the URL into your browser.). Further, in 2013 VA launched the Opioid Safety Initiative (OSI) – the first of several system-wide initiatives to address opioid overuse. By mid-2016 compared with mid-2012, the number of Veterans dispensed an opioid each quarter had decreased by 172,000, or about 25%.

Bohnert A and Ilgen M. Understanding Links among Opioid Use, Overdose, and Suicide. The New England Journal of Medicine. Review Article. January 3, 2019;380(1):71-79.

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