Dr. Kip Bohnert
Dr. Jason Goldstick
Suicide is a significant and growing public health concern, and a leading cause of death in the United States (U.S.). Suicide ranks in the top ten leading causes of death for those ages 10-64, and accounted for almost 45,000 deaths in 2016 in the U.S. In addition to the human toll, suicide annually accounts for more than $50 billion in medical- and work-related losses in the U.S. Further, the U.S. suicide rate has increased approximately 25% since 1999.
Concurrently, opioid misuse and overdose—driven in large part by overprescribing—have grown to epidemic proportions. From 1999 to 2010, sales of opioid analgesics quadrupled in the U.S., mirrored closely by rates of opioid-related overdose deaths, emergency department (ED) visits, and substance abuse treatment admissions. Since 2010, opioid-overdose deaths have further grown by 80%, to total 42,249 in 2016.
Evolving state-level opioid policies aim to prevent opioid-related harms along a continuum. Because most who use opioids non-medically were initially exposed to them via a prescription, many state laws seek to prevent or limit access to prescription opioids (“opioid prescription limitation laws”). Those policies associated with reductions in opioid prescribing and unintentional overdoses include pain clinic regulations, robust prescription drug monitoring programs (PDMP), and prescribing guidelines.
Important prior work links medical and non-medical opioid use and opioid use disorder with psychiatric disorders and increased suicide risk. Because some opioid prescription limitation laws reduce access to prescription opioids, these drugs may be less likely to be used as a means to attempt suicide. Nonetheless, no previous study has examined the relationship between state-level opioid prescription limitation laws and suicide or nonfatal suicide outcomes. To address this important gap in the evidence, we propose to link key national datasets and use innovative epidemiological and policy methods to understand the impact of state-level opioid prescription limitation policies on fatal and nonfatal suicide outcomes. Specifically, we will use data from the Prescription Drug Abuse Policy System (PDAPS), OptumInsight commercial claims, and Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER).