Is the suicide prevention field well-positioned to address the opioid crisis?

Is the suicide prevention field well-positioned to address the opioid crisis?
By Christine Walrath, Ph.D.
Aug 6, 2019

A look at the underlying factors for both types of deaths offers clues for prevention

Suicide and opioid overdose deaths are devastating our communities—129 people die by suicide and 130 people die of opioid overdose on average every day. And as a recent report shows, young people have been hit especially hard by both crises. Understanding the relationship between suicide and opioid overdose deaths can help us identify the most effective response—and determine if suicide preventionists are well-positioned to take on the opioid crisis.

Geographic overlap of youth suicide and opioid overdose deaths

To investigate the geographic overlap of youth suicide and opioid overdose deaths, we recently conducted a national geospatial analysis at the county level. We learned that not only is there a demonstrated link between suicide and opioid-related death, but this link is geographically clustered at the county level.

We then overlaid the presence of national youth suicide prevention activities that are in place and could be positioned to address this intersection.

map showing suicide prevention activities

In the UPPER MAP are the areas where historically suicide and opioid- related deaths were highest. Darker shades of magenta indicate the areas where the prevalence was high for both suicide and opioid-related mortality. The LOWER MAP indicates areas where the overlapping suicide and opioid-related death rate is increasing over time. These maps depict where suicide and opioid-related mortality are happening in the same geographic areas.

While these models establish the mortality link and the presence of existing suicide prevention infrastructure, they don’t explain why the deaths are occurring in the same location. To better understand the root cause, we must turn to what is known in the literature.

Investigating the root cause: deaths of despair

One popular theory on why we are seeing a concurrent rise in both suicide and opioid overdose deaths is the idea that these are “deaths of despair”—drug overdoses, suicides, and alcohol-related mortality fueled by declining fortunes and rising inequality in parts of the country.

This theory was corroborated by best-selling Hillbilly Elegy author J.D. Vance in a panel discussion on combating the opioid epidemic. Vance, whose memoir explores his family’s struggle with opioid addiction in rural Ohio, spoke about the role that economic decline often plays in the opioid crisis.

“People turn to substance abuse because the outlook for their communities seems hopeless…not just for today, but hopeless for the future as well.”

- J.D. Vance

The language Vance uses shows how a feeling of hopelessness—brought on by declining fortunes and rising inequality in certain pockets of the country—has contributed to an uptick in both suicide and opioid-related deaths.

Looking upstream to create more powerful prevention approaches

By looking upstream for the common risk and protective factors, a prevention approach that addresses multiple forms of violence—including suicide and opioid overdose deaths—emerges. For example, stigma around mental health and substance abuse remains a significant hurdle for those who are seeking help. Thus, creating social marketing campaigns that alter community norms about substance use and mental health is one way to fight this stigma. By breaking down issue-specific silos and looking upstream for common threads, we can devise more effective solutions—creating a whole prevention approach that is far stronger than the sum of its parts.

In our recent webinar, Jarrod Hindman from the Colorado Department of Public Health and Environment shared additional upstream approaches to addressing the intersecting suicide and opioid overdose crises. Colorado identified common risk and protective factors among those at risk for violence or injury, and then organized them into concepts of connectedness, positive social norms, good behavioral health, economic stability, and resilience. Each of these larger concepts includes specific risk and protective factors across the social ecology. By looking upstream, Colorado has developed approaches that more effectively leverage limited resources and valuable partnerships—in the hopes of preventing multiple forms of violence and injury.

Data-driven approaches to addressing suicide and opioid crises

Data is often used to identify the health problem. But it can also be used to target your response, measure progress addressing the problem, and demonstrate success. One example of a data-driven approach to program measurement is our work with the Substance Abuse and Mental Health Services Administration (SAMHSA).

We partnered with SAMHSA to measure the impact of a program called the Garrett Lee Smith Youth Suicide Prevention Program. Our team developed a multi-site evaluation based on qualitative and quantitative data collected from a wide sample of GLS grantees to measure the effectiveness of the program—which led to continued program support.

Suicide preventionists are poised to address the opioid crisis

There is a link between suicide and opioid overdose mortality at the county level, and high-risk counties are clustered across the country. Youth suicide prevention activities and infrastructure exist in many of these same high-risk areas across the country, positioning suicide preventionists on the front lines of these overlapping crises.

With their history of building strong grass-roots collaborations in the community to combat the stigma of suicide and mental health, suicide preventionists can build upon these existing skills and networks to expand their reach and to concurrently address the suicide and opioid misuse crises in our communities.

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Meet the author
  1. Christine Walrath, Ph.D., Senior Vice President and Chief Science Officer, Public and Behavioral Health Research and Evaluation

    Christine is a public and behavioral health expert with more than 25 years of experience in federal, state, and local health policy and program research and evaluation. View bio