WHAT IS THE LEAST PAINFUL WAY TO DIE DRIVER
The primary driver behind some people’s substance use (regardless of whether the drug is legal, illicit or pharmaceutical in nature) is to medicate distress so that unmanageable feelings go away, irrespective of the cost. Thus, many overdoses and deaths fall into a grey area where a clear intent to die is absent or uncertain, yet preventing death is not the focus either. This means that official statistics are likely to grossly underestimate the size of the problem, and key information related to these deaths is not available to inform suicide prevention strategies or relevant clinical responses. However, the classification systems that inform official statistics require that deaths where intent is unclear must rightly be considered unintentional or accidental. Peer-administered naloxone and access to supervised injecting facilities will support those who do not intend self-harm, but where issues underpinning the overdose are historical trauma, mental ill health or chronic severe pain, alternative prevention strategies are also required. Importantly, overdoses where the intent is unclear are unlikely to be prevented through existing overdose prevention strategies. Opioid-related ambulance attendances were also triggered by financial distress, consistent with a phenomenon in the US termed "deaths of despair", where poisoning and suicide have been linked to economic insecurity and stress. Similarly, in a recent Australian study examining ambulance attendances related to prescription opioids, we identified that acute harms were mostly associated with pharmaceuticals taken to cope with psychological distress, physical pain or social stressors. For example, in a study examining more than 4500 overdose presentations to a US emergency department, 39% of those whose most serious overdose involved an opioid or sedative reported that they wanted to die or did not care about the risks, and another 15% were unsure of their intentions. There's growing evidence that an escape from underlying physical or emotional pain is a common driver of many overdoses. Where the person was ambivalent about whether they would live or die, the task of coding becomes almost impossible. That evidence is difficult to find in any intentional death, but for those who suicide by drug overdose, it's even more complex. So, what do we know about the proportion of overdose deaths that are intentional, or where intent is undetermined?Ī key methodological challenge here is that coding systems that provide official statistics, such as the International Classification of Diseases, require clear evidence of suicidal intent before the death can be considered to be intentional. Such findings are consistent with research identifying high rates of suicidal ideation and attempts among Australians prescribed opioids for chronic non-cancer pain, many of whom report high rates of physical and mental ill health. While there are likely to be many factors involved, Australian research has found prescription opioid deaths are twice as likely to be identified as intentional when compared with heroin-related deaths.
In the US, forced tapering or sudden discontinuation of opioid prescriptions have been followed by an increase in overdose deaths. While such strategies are likely to be important in reducing the number of Australians who develop long-term opioid medication dependence, the effect on those who already rely on opioids for pain management is less clear.
WHAT IS THE LEAST PAINFUL WAY TO DIE FULL
However, we're yet to understand the full impact of these measures in terms of reducing deaths.
It's a time to remember those lost to overdose, and acknowledge the enormous loss and grief felt by families and friends. This Monday, 31 August, is International Overdose Awareness Day.