Prescription Drug Abuse & Suicide

SAVING GENERATION RX: PREVENTING PRESCRIPTION DRUG ABUSE IN

EAST TENNESSEESEPTEMBER 19TH, 2014

SAMANTHA NADLER, B.S.TENNESSEE SUICIDE PREVENTION NETWORK

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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.

2CDC/AFSP/AAS

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.

3CDC/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 DeathsRate

♂ 31,003 20.2

♀ 8,515 5.6

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Tennessee United StatesFirearms 64.9% 50.6%Suffocation 18.6% 25.1%Poisoning 12.9% 16.6%

All other means (cutting, jumping, etc.) are < 2%

MEANS OF SUICIDE - 2011

Poisoning includes …

OverdoseRx, OTC, & Street Drugs Alcohol Frequently Multiple Substances

Ingestion of poisonous compounds

Exposure to toxic fumes, etc.

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Overdoses

Up 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 .

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Poisoning Deaths vs. Motor Vehicle Traffic Deaths

In 2008, poisoning deaths exceeded MVT deaths for the first times since at least 1980. Poisoning deaths nearly tripled MVTs are decreasing Poisoning deaths caused by drugs increased from

60% to 90%.

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Drug Poisoning Death Rates,

by Intent - USA, 1999-2009

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Facts About Suicide

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.

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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 = 45 times the riskAtivan, Xanax, Librium, Klonopin,

Valium, Dalmane, Restoril, Halcion

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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

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The Triple Dynamics of Substance Abuse and Suicide

Prescription Drugs & Suicide

Rx abuse Risk factorIatrogenic factor Means of suicide

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“Risk Factors” for Suicide are …

Characteristics of a person that make

it more likely that individuals will consider, attempt, or die

by suicide.

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Major Risk Factors for Suicide

Psychiatric disorder, esp. Mood Disorders90% 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

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Abuse of Prescription Drugs

Significant 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 prescribedUsing the medications of others,Buy prescription drugs off the streetEtc.

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Iatrogenic factor

…“of a medical disorder caused by the diagnosis, manner, or treatment of a physician.”

…“doctor caused sickness”

Examples: Getting an infection at the hospital.

Adverse reactions to a medication.

Doctor allows the natural history of a disease to progress untreated.

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Medications Have Been “Linked” to Depression and/or Suicide Anti-Depressant Medications - SSRIs

Pain Killers Opioid Analgesics

Anticonvulsants

Inteferon/Ribavirin Therapy

Etc.

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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

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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.

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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

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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 %

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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

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Are there any questions?

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This project is funded under an agreement with the State

Of Tennessee.

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Contact Information

Tennessee Suicide Prevention Network295 Plus Park Blvd., Ste. 201

Nashville TN 37217615-297-1077–main line 615-269-5413-fax

Scott Ridgway, M.S.Executive Directorsridgway@tspn.org

Samantha Nadler, B.S.Middle Tennessee Regional Coordinator

snadler@tspn.org

Vladimir Enlow, M.T.S.Executive Assistantvladimir@tspn.org

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