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Newly discovered connection between specific drugs and violent suicide raises public health questions

As of 2013 in ŷ���ڱ���Ƶ, suicide was the seventh leading cause of death and the number one cause of violent death. It is the 10th leading cause of death in the United States.

In studying social elements and risk factors related to suicide, sociologists at the University of ŷ���ڱ���Ƶ Boulder recently found a surprising association between specific drugs found in victims at the time of death and the method by which they committed violent suicide. Opiates were considerably more likely to be found in victims who died by self-inflicted gunshot wounds, while those who hanged themselves were more likely to have taken antidepressants.

“The postmortem presence of opiates was associated with a 92 percent increase in the odds of suicide by firearm relative to the odds of suicide by hanging,” says study co-author Jason Boardman, director of the Health and Society Program at the Institute of Behavioral Science, and a professor in the Department of Sociology.

Meanwhile, the presence of antidepressants is associated with a 45-percent increase in the odds of hanging compared to firearm-related suicides. But the authors are particularly interested in the sociological implications of death by firearm related to opiates.

Lead author Connor Sheehan, who obtained his master’s degree in geography at ŷ���ڱ���Ƶ-Boulder and is now a Population Research Center trainee at the University of Texas at Austin, explains the combination may shed some light on the timeline of a suicide.

“What I really think is going on is that some people may suffer from longer-term depression and thus seek out, and are prescribed, antidepressants,” Sheehan says. The use of hanging may indicate a planned event over a long period of depression or mental health problems.

“On the other hand, someone might go through a very stressful or abrupt event and choose to self-medicate with opiates and then use a firearm,” Sheehan says.

On the broader social level, “the opiate and firearm combination potentially gives us clues about the relevance of anomic suicide,” Boardman explains.

"Our results can assist policymakers in breaking the vicious cycle between drug use and violent deaths, including some suicides.”

Anomic suicide, a term coined by famous French sociologist Emile Durkheim, occurs when a person doesn’t feel as though they have a place in society or a group that helps define their aspirations, purpose and direction.

Basically, people who have a healthy level of inclusion, through relationships, cooperation and reciprocal exchange, are less likely to commit suicide than people who aren’t fully engaged in these underlying social structures.

“Antidepressants and hanging, in combination, give us psychiatrically oriented information, whereas the gunshot, in combination with opiates, may be an indicator that preventative social mechanisms aren’t in place,” Boardman says.

Co-author Richard Rogers, sociology professor and director of the Population Program at IBS focuses on the public health implications of the new findings. Rogers researches demographic factors that contribute to health, longevity and mortality.

“It is useful to look at suicide because it contributes to premature death,” Rogers says. “If you can prevent suicides, you can potentially contribute to many more years of life someone can gain.”

Hanging and firearm suicides are particularly relevant because they make up 71 percent of suicides in ŷ���ڱ���Ƶ and 78 percent nationally.

“Our results can assist policymakers in breaking the vicious cycle between drug use and violent deaths, including some suicides,” Rogers says.

The researchers used the ŷ���ڱ���Ƶ Violent Death Reporting System (COVDRS) to analyze 3,389 hanging and firearm suicides from 2004-2009. A state-based initiative of the Centers for Disease Control (CDC), the data are collected from law enforcement officials, medical examiners and coroners, and crime laboratories.

The COVDRS represents a special opportunity for researchers because it provides detailed demographic and mortality information on every violent death in the state, as compared to data sets that only sample certain populations.

“It’s rare you get information on toxicology reports and method of suicide,” Rogers says. “We can drill down much further than one could with larger but less detailed data sets.”

Although the data clearly show a connection between method of suicide and specific drugs, the authors stress that the information cannot be used to draw causalities, nor should it be used to speculate on the probability of committing suicide.

“It’s hard to know whether the drug itself is a cause or if just an indicator of a lifestyle,” Rogers observes. “Also, at no point do we make comparisons to people who kill themselves and those who don’t.”

To properly study the nature of the relationship between drug presence, drug use and suicide, the researchers would need to have longitudinal data collected between a range of contexts.

“It’s a baseline,” Rogers says of the study, published in Journal of Drug Issues. “We have established a foundation that others can develop over time and use as a springboard for the next research project.”

“This may be one small but critical piece that could contribute to alleviating some suicides.”

Meagan M. Taylor is a ŷ���ڱ���Ƶ alumna and an Advanced EMT student at St. Anthony Institute of Emergency Medical Training. For information about suicide prevention, click .