Death Ambivalence and Treatment Seeking: Suicidality in Opiate Addiction

Abstract

Purpose of review: Rates of suicide and opiate overdose have recently skyrocketed in the USA. In light of impulsivity and impaired motivation common in people with substance use disorders, suicidality is common in addiction. Recent findings: Chart review surveys indicate two primary suicidal populations that are important to distinguish for clinical practice and healthcare policy. One group is heavily composed of people with substance use disorders, in whom chronic compulsive use fosters a numb ambivalence about death (low death intentionality). Many of these individuals with opiate use disorder (OUD) exaggerate suicidality to get prompt psychiatric care to treat the OUD. The second group is composed of those who have comorbid psychiatric disorders and/or chronic pain who have a higher intent to die consistent with traditionally understood suicide risk factors. Summary: We contend that easier access to outpatient opiate agonist treatment would avoid unnecessary hospitalizations for death-ambivalent OUD patients and for OUD patients in either group. First-line treatment with an opioid agonist has high potential to effectively treat suicidal ideation as a secondary benefit.