Detecting Suicidality in Opioid Use Disorder Requires an Understanding of Intentional Opioid Overdose

Since 2000, the suicide rate from opioid overdoses has more than doubled, and the number of self-reported intentional opioid overdoses is likely undercounted. This commentary discusses how a sensitive and validated assessment is crucially needed to identify those at risk for intentional opioid overdose. Developing this, however, requires an understanding of the affective, cognitive, and behavioral factors that uniquely contribute to this phenomenon. These include higher prevalences of psychiatric diagnoses and pain in the opioid use disorder (OUD) population; a deleterious negative emotional state that occurs with chronic opioid use; and risky opioid-use patterns worsened by the introduction of fentanyl into the illicit opioid supply that give individuals with OUD easy access to lethal means for dying by suicide. Although there is an urgent need to identify intentional opioid overdose risk, previous research has shown that validated screening tools for suicide risk, which ask about previous suicide attempts, may not detect all those at risk for intentional opioid overdose. This may be because the intent preceding opioid overdoses is ambiguous, making it challenging for individuals with OUD to identify these as suicide attempts. Because validated screening tools for suicide risk are insufficient for detecting intentional opioid overdose risk, a screening tool developed specifically for this purpose using validated psychometric methods is necessary to identify and intervene in the morbidity and mortality associated with intentional opioid overdose.