1. Prescription Drug Abuse & Suicide SAVING GENERATION RX: PREVENTING PRESCRIPTION DRUG ABUSE IN EAST TENNESSEE SEPTEMBER 19 TH, 2014 SAMANTHA NADLER, B.S. TENNESSEE SUICIDE PREVENTION NETWORK 1

2. Facts About Suicide  39,518 people died by suicide in 2011 in the United States.  938 people died by suicide in 2011 in Tennessee.  Approximately 317,305 people had thoughts of suicide in Tennessee in 2011 (5% of population).  Over 1 million people attempt suicide each year, according to a recent SAMHSA study. 2 CDC/AFSP/AAS

3. Facts About Suicide  Suicide was the 10 th leading cause of death for all age groups (2011).  Suicide was the 2 nd leading cause of death of ages 10-24.  Someone dies by suicide approximately every 13.3 minutes.  Someone aged 10-24 dies by suicide approximately every 1.75 hours. 3 CDC/AAS

4. E STIMATES O N A TTEMPTS 25 attempts for each documented death

5. Gender and Suicide - 2011  Men are nearly 4 times more likely to die by suicide than women.  Women attempt suicide 3 times as often as men.  GenderDeathsRate ♂31,00320.2 ♀ 8,515 5.6 5

6. Tennessee United States  Firearms 64.9%50.6%  Suffocation 18.6%25.1%  Poisoning 12.9%16.6% All other means (cutting, jumping, etc.) are < 2% M EANS OF S UICIDE - 2011

7. Poisoning includes …  Overdose  Rx, OTC, & Street Drugs  Alcohol  Frequently Multiple Substances  Ingestion of poisonous compounds  Exposure to toxic fumes, etc. 7

8. Overdoses  Up to 75-90% of all intentional poisoning deaths are by drugs or alcohol in the U.S.  At the same time, another study reports that the average fatality rate for overdose is estimated to be only 1.8%.  It is frequently challenging to separate intentional from accidental. 8

9. Poisoning Deaths vs. Motor Vehicle Traffic Deaths  In 2008, poisoning deaths exceeded MVT deaths for the first times since at least 1980.  Poisoning deaths nearly tripled  MVTs are decreasing  Poisoning deaths caused by drugs increased from 60% to 90%. 9

10. Drug Poisoning Death Rates, by Intent - USA, 1999-2009 10

11. Facts About Suicide  People with substance abuse (SA) disorders are at elevated risk for suicidal ideation and attempts.  People who have been treated for SA at 10 times greater risk to eventually die by suicide than the general population. 11 Kelller, Borges, & Walters 1999

12. Prescription Drugs Dependency & Suicide Risk  People dependent on certain kinds of medications are at increased to die by suicide as the general population:  Opioid Painkillers = 14 times the risk  Morphine, Hydrocodone, Oxycodone  Benzodiazepines = 45 times the risk  Ativan, Xanax, Librium, Klonopin, Valium, Dalmane, Restoril, Halcion 12

13. Substance Abuse & Suicide  ~30 percent of deaths by suicide involved alcohol intoxication –  Blood Alcohol Content (BAC) at or above legal limit (.08%)  ~ 40-66 percent of people who die by suicide have a positive BAC 13

14. The Triple Dynamics of Substance Abuse and Suicide  1 - RISK FACTOR for suicide  2 - ACUTE Substance Use (Getting drunk or high)  Decreased fear – (FEAR is protective)  Pain, “Screwing it up!”, Disfigurement  Decreased impulse control  3 – MEANS of Death

15. Prescription Drugs & Suicide  Rx abuse  Risk factor  Iatrogenic factor  Means of suicide 15

16. “Risk Factors” for Suicide are … Characteristics of a person that make it more likely that individuals will consider, attempt, or die by suicide. 16

17. Major Risk Factors for Suicide  Psychiatric disorder, esp. Mood Disorders  90% of the people who die by suicide have a mental health diagnosis.  Substance –related Disorders  Co-Occurring Disorders  Prior suicidal behavior  Access to lethal means 17

18. Abuse of Prescription Drugs  Significant risk factor  “Abuse" is any use of a prescription drug except as prescribed by a physician to treat a medical condition.  Using a higher doses than prescribed  Using the medications of others,  Buy prescription drugs off the street  Etc. 18

19. Iatrogenic factor  …“of a medical disorder caused by the diagnosis, manner, or treatment of a physician.”  …“doctor caused sickness”  Examples:  Getting an infection at the hospital.  Adverse reactions to a medication.  Doctor allows the natural history of a disease to progress untreated. 19

20. Medications Have Been “Linked” to Depression and/or Suicide  Anti-Depressant Medications - SSRIs  Pain Killers  Opioid Analgesics  Anticonvulsants  Inteferon/Ribavirin Therapy  Etc. 20

21. Selective Serotonin Reuptake Inhibitors (SSRI)  Prozac, Paxil, Lexapro, Luvox, Zoloft, etc.  Treatment for depression & anxiety disorders  2004 – FDA reviewed clinical trials with kids   “Black Box Warning”   Significant reduction in treatment for children.  Very unclear whether SSRIs affect adult suicidality 21

22. Selective Serotonin Reuptake Inhibitors  Later research  only a small increase in suicidal risks with SSRIs, but a much greater benefit to taking the medication.  Depression carries it’s own risk for suicide.  Sadly, many who could have benefitted from treatment did not get the treatment they needed.  Risk-benefit analysis needed. 22

23. Prescription Drugs as Means of Suicide  75% of poisoning by alcohol and/or drug overdose  47% had no known substance abuse problem  ~ 25% ingested two or more drugs.  ~ 8% = ETOH & Rxs  ~ 8% = OTC & Rxs  ~ 69% Used 1 type of Drug  ~ 6% Unknown 23

24. Suicide with Single Type Substance Overdose  Prescription drugs = 79% of deaths due to drugs  Opioid (morphine, hydrocodone, oxycodone)  Benzodiazepines (Valium, Xanax, Librium, Klonipin)  Antidepressants (SSRIs, Tricyclics)  Over-the-counter = 10% (especially Acetaminophen)  Street drugs = 2%  ETOH = 1%  Other specified substances = 6 % 24

25. Take Action!!!  Participate in TSPN  Monthly meetings all over the state  Regional Resource Directories  Get training – It’s Free  Suicide Prevention  Postvention  Keep doing what you are doing 25

26. Are there any questions? 26

27. This project is funded under an agreement with the State Of Tennessee. 27

28. Contact Information Tennessee Suicide Prevention Network 295 Plus Park Blvd., Ste. 201 Nashville TN 37217 615-297-1077–main line 615-269-5413-fax Scott Ridgway, M.S. Executive Director sridgway@tspn.org Samantha Nadler, B.S. Middle Tennessee Regional Coordinator snadler@tspn.org Vladimir Enlow, M.T.S. Executive Assistant vladimir@tspn.org 28