Attempted suicide among long term heroin users: Results from the Australian Treatment Outcome Study
Background: Opioid use is associated with a risk of completed suicide risk 14 times the general population. The authors examined data from the 11 year follow up of the Australian Treatment Outcome Study cohort to ascertain lifetime and recent rates of attempted suicide and suicidal ideation. On average the group had first started using heroin use 20 years prior.
Results: Suicide and suicidal ideation remained a significant clinical issue for heroin users, some 20 years after their heroin use commenced. At 11-year follow-up, 42.2% of the cohort reported ever having made a suicide attempt. In the year preceding 11-year follow-up, 1.6% had made an attempt, suicidal ideation was reported by 10.4%,and 4.2% had a current suicide plan. Current ideation or plans were independently associated with a current diagnosis of Major Depression and more extensive polydrug use.
Implications: The current study has clinical implications for the management of opioid dependence. It would appear wise for those treating heroin dependence to screen regularly for attempts, ideation and plans. In conducting such screens, it should be noted that there is no evidence that asking such questions increases the risk of suicide, a concern frequently raised by clinicians. Clinical staff should also be aware that while drug use may improve, heroin users remain at elevated risk over substantial periods of time, particularly if they are in poor physical health. Moreover the treatment of physical health and comorbidity would appear to be a clinical priority. The absence of an association with drug treatment histories is of concern, and indicates the scope for such intervention.