Perspectives in Disease Prevention and Health Promotion
Suicide and Suicide Attempts by the Nonmedical Use of Drugs
For 1983, the Drug Abuse Warning Network (DAWN) was notified of
2,975 deaths attributed to drug abuse and 108,585 drug abuse
incidents. Although it is not a population-based surveillance
system,
DAWN, sponsored by the National Institute on Drug Abuse, monitors
nonmedical use of drugs through 76 medical examiner facilities and
760
emergency rooms (1).
Of the 2,975 deaths related to drug abuse, 1,097 (37%) were
classified as suicides. Attempted suicides were reported for
42,294
(39%) of the drug abuse incidents. More than half (53%) of persons
whose deaths were attributed to suicide by drug overdose were
female;
67% of persons attempting suicide by drug overdose were female.
Death
by drug overdose occurred in an older age group than did suicide
attempt by drug overdose: 71% of deaths were among persons older
than
30 years, whereas approximately 40% of persons attempting suicide
were
older than 30 years.
Alcohol in combination with some other substance was most
commonly
used in both suicides and suicide attempts reported to DAWN (Table
1). Alcohol was involved in 21% of suicides and 20% of suicide
attempts. Amitriptyline, a prescription antidepressant, was used
in
16% of suicides but only 4% of suicide attempts.
Reported by Div of Epidemiology and Statistical Analysis, National
Institute on Drug Abuse, ADAMHA; Violence Epidemiology Br, Center
for
Health Promotion and Education, CDC.
Editorial Note
Editorial Note: DAWN is a large data base but is neither a
representative sample nor a population-based registry. Therefore,
rates for drug-related suicides and suicide attempts cannot be
calculated, and generalizations based on DAWN data may not be
valid.
DAWN data complement vital statistics information for suicide and
provide additional clarification of drug-related suicide attempts
by
listing specific substances ingested.
Nonmedical use of drugs is cited as the method most frequently
used in suicide attempts (2). However, suicide by self-poisoning
(International Classification of Diseases, 9th Revision, E950),
which
includes nonmedical use of drugs, is decreasing in frequency in the
United States (3). Between 1970 and 1980, suicide by
self-poisoning
decreased from 17% to 11% of all suicides. The total number of
suicides has increased during the same period (3).
The high frequency of aspirin and acetaminophen ingestion
reported
in suicide attempts underscores the availability of these
nonprescription drugs. Among prescription drugs used,
amitriptyline,
seldom abused for psychic effects, was the most frequently
mentioned
prescription substance used for suicide in DAWN reporting. Persons
committing suicide by amitriptyline overdose are likely to have
been
in treatment for depression; depression is a significant risk
factor
for suicide (4). Limiting the number of pills per prescription,
writing only nonrefillable prescriptions, and scheduling frequent
office visits to assess patient response and to inquire about
suicidal
thoughts may help reduce deaths from antidepressant overdose.
References
National Institute on Drug Abuse. DAWN. Annual Data, 1983.
Rockville, Maryland: National Institute on Drug Abuse, 1984.
DHEW publication no. (ADM) 84-1353. (Statistical series; series
1,
no. 3).
Wexler L, Weissman MM, Kasl SV. Suicide attempts 1970-1975:
updating a United States study and comparisons with
international
trends. Br J Psychiatry 1978;132:180-5.
CDC. Suicide surveillance. Atlanta, Georgia: Centers for
Disease Control, 1985.
Egeland JA, Sussex JN. Suicide and family loading for affective
disorders. JAMA 1985;254:915-8.
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