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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. Facts About Suicide. 39,518 people died by suicide in 2011 in the United States. - PowerPoint PPT Presentation
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Prescription Drug Abuse & Suicide
SAVING GENERATION RX: PREVENTING PRESCRIPTION DRUG ABUSE IN
EAST TENNESSEESEPTEMBER 19TH, 2014
SAMANTHA NADLER, B.S.TENNESSEE SUICIDE PREVENTION NETWORK
1
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.
2CDC/AFSP/AAS
Facts About Suicide
Suicide was the 10th leading cause of death for all age groups (2011).
Suicide was the 2nd 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.
3CDC/AAS
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.
Gender DeathsRate
♂ 31,003 20.2
♀ 8,515 5.6
5
Tennessee United StatesFirearms 64.9% 50.6%Suffocation 18.6% 25.1%Poisoning 12.9% 16.6%
All other means (cutting, jumping, etc.) are < 2%
MEANS OF SUICIDE - 2011
Poisoning includes …
OverdoseRx, OTC, & Street Drugs Alcohol Frequently Multiple Substances
Ingestion of poisonous compounds
Exposure to toxic fumes, etc.
7
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
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
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
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 riskAtivan, Xanax, Librium, Klonopin,
Valium, Dalmane, Restoril, Halcion
12
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
“Risk Factors” for Suicide are …
Characteristics of a person that make
it more likely that individuals will consider, attempt, or die
by suicide.
16
Major Risk Factors for Suicide
Psychiatric disorder, esp. Mood Disorders90% 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
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 prescribedUsing the medications of others,Buy prescription drugs off the streetEtc.
18
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
Medications Have Been “Linked” to Depression and/or Suicide Anti-Depressant Medications - SSRIs
Pain Killers Opioid Analgesics
Anticonvulsants
Inteferon/Ribavirin Therapy
Etc.
20
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
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
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
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
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
Contact Information
Tennessee Suicide Prevention Network295 Plus Park Blvd., Ste. 201
Nashville TN 37217615-297-1077–main line 615-269-5413-fax
Scott Ridgway, M.S.Executive [email protected]
Samantha Nadler, B.S.Middle Tennessee Regional Coordinator
Vladimir Enlow, M.T.S.Executive [email protected]
28