A new $1 million grant was added to a $6.8 million study from 2015 attempting to determine intentionality of opioid overdoses in people recently released from prison. Former prisoners are at high risk of mental illness and drug relapse, making them highly susceptible to suicide, said Jennifer Johnson, professor of public health at Michigan State University.
The ongoing study aims to determine interventions to reduce suicide, Johnson said. If the research is effective, this would reduce 5 to 9 percent of all U.S. suicides, she said. “The goal with the new million-dollar project is to better inform emergency departments and emergency responders” of what kind of treatment may be effective, she said.
“This study was designed specifically to address suicide risk in individuals who were transitioning from jail detention back to their community,” said Lauren Weinstock, associate professor of psychiatry and human behavior. “With additional funding, we can start looking a little bit more at how opioid addiction and drug addiction affects suicide behaviors.”
The study, which orginally intended to research suicide prevention for society in general, found that those at a higher risk were recently released prisoners, Johnson said. The study “shows how suicide and substance use co-occur in our population,” she added. More than half of incarcerated people have substance abuse problems, she said.
“Ten percent of all suicides with known causes occurred in the context of a recent criminal or legal stressor,” Johnson said. Studying people in jail “was a way to identify people at risk for suicide in the community … who are not in contact with formal treatment services.”
“Risk of death soon after discharge from prison due to overdose is very high,” said Stephen Buka, professor of epidemiology.
However, the “proportion of the opioid overdose deaths that we’ve seen can be attributed to suicide rather than drug overdose,” Weinstock said. The researchers followed the former prisoners for up to a year after they were released and observed that many of them had considered using opioids for suicidal purposes, Weinstock said. These “people have contemplated that (overdose) would appear accidental so that their loved ones wouldn’t necessarily know that they’ve committed suicide,” she added.
“There are people who get into drugs to self-medicate their problems,” said Josiah Rich, professor of medicine and epidemiology. “We see some folks who are suicidal because they feel they can’t recover from substance abuse.”
Further, many people go to the emergency department either from intentional or unintentional overdose, but they decline future treatment, Weinstock said. The researchers spoke to health care providers across the country who had seen overdose patients and found that these providers assumed the overdoses were accidental, Johnson said.
When people are going through withdrawal from opioids, they are less likely to tell health care providers they were suicidal so that the hospital does not hold them, Rich said. Since people do not want to experience the symptoms of withdrawal, they do not seek further treatment, Johnson said.
But researchers are interested in finding more effective treatments. “It doesn’t surprise me that (the former prisoners) are candid with researchers (who) are all about the mental health needs of the ex-prisoners and are there in the context of help,” Buka said.
Researchers are also looking at intervention methods already being implemented in prisons.
Whereas European nations work to treat addiction in prisoners, the United States does not have a treatment plan, Rich said. “Rhode Island prisons are way ahead of the curve in providing treatment and counseling to those who are addicted to opioids while they are in prison,” Buka said.
Access to opioids is extremely dangerous for someone who is at risk for suicide, Johnson said. “One important consideration is minimizing access to opioids as a means for someone having access for an overdose,” she added.
Ninety percent of people who detox from addiction end up relapsing, Rich said. “Now is the most dangerous time ever to use opioids because they are contaminated. When you relapse and you’ve lost your tolerance, you’re set up for an overdose,” he added.
