Factors Associated with Attempted Suicide Among Emergency Department Patients with Nonfatal Opioid Overdose

Introduction: To investigate factors associated with suicide attempts among patients presenting after an opioid overdose.

Materials and methods: This analysis consists of patients enrolled in the Toxicology Investigators Consortium Fentalog Study, an ongoing prospective observational study of patients presenting to 1 of 10 emergency departments (EDs) for a suspected opioid overdose. Residual serum samples were analyzed to detect over 1,200 drugs and metabolites. Chart reviews were conducted to determine the patients' intentions for the opioid overdose (suicide attempt vs. unintentional overdose), medical/social history, and clinical variables. Logistic regression analyses were conducted to examine factors associated with suicide attempts.

Results: Among 1,259 patients, 6.4% were classified as suicide attempts. Prescription opioids only (without illicit opioids) were associated with suicide attempts compared to unintentional overdose (OR: 1.27; 95% CI: 1.21, 1.34). Compared to unintentional overdoses, suicide attempts were not associated with an increased odds of medical interventions being provided, such as CPR, intubation, or ICU admission.

Conclusions: Among patients presenting to EDs after opioid overdose, suicide attempts comprised 6% of the study population and were associated with prescription opioids rather than illicit opioids.