Undetermined

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Opioid deaths are generally classified as accidental overdoses. In 2017 Massachusetts began reporting opioid deaths as “All Intents” where they previously reported them as “Unintentional/Undetermined.” They point out that adding suicide deaths only marginally adds to the count. By their statistics only 2 percent of the total opioid deaths were confirmed as suicides.

Massachusetts Opioid Death Data

Connecticut reports opioid deaths under the term accidental drug related deaths. If a person left a suicide note, and then injected themselves with heroin, they would not count in the state’s totals.  In most cases, it is hard to say with determination the overdose was a suicide.

An article published on March 28 in Medscape asks “How many Opioid Overdoses Are Suicides?” It offers fairly persuasive arguments that the numbers are much higher than reported.

How Many Opioid Overdoses Are Suicides?

Dr. Maria Oquendo, the past president of the American Psychiatric Association, is quoted as saying based on published studies, the suicide rate could be anywhere from 24 to 45 percent of all opioid deaths.

Should this change the way we view the current crisis? I don’t think so. There is a strong link between addiction and mental illness. I have read many articles that speculate that many users use not just because their brain has been rewired by the opioid overloading their circuits, and replacing the normal human drives for food, sex, and protection of our children with the need to use heroin, but because fundamentally many people use opioids to escape loneliness, shame, and despair.

One argument made along these lines is the fact that supposedly 90% of Americans addicted to heroin in Vietnam came home and were able to kick the habit because they were put back in places where they had strong support networks, families and jobs so they could function as members of society.

What Vietnam Taught Us About Breaking Bad Habits

The other argument involves the famous rat park study. Previous studies showed rats would drink drugs until they died. Another researcher on learning that the rats, social animals by nature, were kept confined in small cages with no interaction with other rats, went ahead and built a rat amusement park where they had food, running wheels and lots of companionship including rats to mate with. Guess what? The rats drank 19 times less opioid solution than the rats that were kept in isolation. Even rats that had been in isolation and were addicted, when put in the rat park, stopped using the drugs.

Rat Park Addiction Study

What did that experiment show? Isolation and despair led to addiction while social interaction helped avoid it.

When we treat users like human garbage and berate them, and then release them from the ED two hours later in withdrawl with the instructions to stop using heroin, how can we expect them not to use a drug that if only for a short while will make them forget about how bad their life has become?

I think many people addicted to drugs who have fallen to the bottom may not have the strength to climb back up. Some may just give up. Maybe one night, instead of doing five bags of No Evil, they decide to do ten.  Goodbye world.

Accident or suicide?  You can call it undetermined.  But either way, another human being is lost to us.

Posted in ems-topics.

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