The percentage of people who died by suicide and who had opiates in their system more than doubled from 2006 to 2017, particularly in the most recent years, according to new research being presented at the American Psychiatric Association’s Annual Meeting in New York, NY.

The rate of suicide in the US is on the rise; about 45,000 people died by suicide in 2016 up from about 35,000 in 2007. Similarly, opiate use is increasing. Substance use is an important risk factor for depression and suicide. Previous research has found increasing rates of accidental opiate overdose as well as opiate use listed as a contributor to death by suicide. However, death investigation and documentation is not uniform across jurisdictions.

Maryland has a statewide medical examiner system that uses strict protocols to prepare full toxicology reports on all suicides and unexplained deaths. These data were used to evaluate opiate prevalence in 5,876 people who died by suicide in Maryland from 2006 to the first half of 2017.

Study authors Paul Nestadt, MD; Ramin Mojtabai, MD, MPH, PhD; and Daniel Borota, with Johns Hopkins University, looked at the proportion of people who tested positive for opiates at the time of suicide each year over the 10-year period, controlling for age, sex, and race. The same analysis was conducted for presence of cocaine and for alcohol intoxication to determine if any change in prevalence was unique to opiates.

The percentage of people who died by suicide and who had opiates in their system doubled from 8.8% in 2006 to 17.7% in 2017. There was no significant change in the proportion of people who were positive for cocaine or alcohol intoxication. The largest increases in positive opiate tests were found in 2014 through 2017, and the increase was most prominent in non-whites and in males.

When overdose suicides were removed from the sample (to eliminate deaths where opiates may have been used as a method of suicide) the increase in opiate prevalence was slightly more pronounced. These results suggest that opiates are playing an increasing role in completed suicides, even outside of overdoses, the authors concluded. Increased vigilance and awareness for suicidality is warranted, they suggest, among both opiate prescribers and users.