ORN Summer 2025 - Suicide and Overdose Risk in Opioid Use Disorder-2025-09-11

Video Transcription

Video Summary

Dr. Max Spaderna presented on the intersection of suicide and overdose risk in opioid use disorder (OUD) during the Opioid Response Network Hot Topics series. Highlighting the U.S. opioid crisis, he described three waves of increasing overdose deaths—from prescription opioids in the 1990s, heroin in the 2000s, to the recent surge of synthetic opioids such as fentanyl. Simultaneously, suicide rates have risen since 2000, raising questions about connections between these twin crises.<br /><br />Suicide risk in OUD is primarily assessed through suicidal thoughts and behaviors, the only current clinical indicators. OUD patients often experience psychiatric comorbidities—depression, anxiety, PTSD, bipolar disorder—at rates far exceeding the general population, significantly elevating suicide risk. Negative affect during opioid withdrawal mimics depressive symptoms, reinforcing this risk. Social factors, including marginalization, unstable housing, incarceration, and limited treatment access, further compound vulnerabilities.<br /><br />Fentanyl’s proliferation increases access to highly lethal means, raising overdose fatality risk. Research indicates that many opioid overdoses may involve some suicidal intent, though intent is often ambiguous. Screening tools vary widely in sensitivity; the Ask Suicide Screening Questions (ASQ) tool identified substantially more suicide risk than other measures, with psychiatric symptoms predicting suicide risk more strongly than substance use severity.<br /><br />Dr. Spaderna’s ongoing research explores intentional opioid overdoses—reported by about 8% of OUD patients—often linked to childhood trauma and psychiatric severity rather than opioid use alone. Qualitative interviews aim to develop improved screening tools to identify risk more effectively. Telemedicine-based psychiatric care, as implemented in the University of Maryland’s RISE Clinic, offers a promising low-barrier approach to engage this high-risk population.<br /><br />Overall, comprehensive suicide risk assessment and integration of psychiatric care into OUD treatment are critical to addressing this complex public health challenge.

Keywords

opioid use disorder

suicide risk

overdose deaths

fentanyl

psychiatric comorbidities

opioid withdrawal

social determinants

suicide screening

intentional overdose

telemedicine psychiatric care