Authors of the new study investigated whether the timing of teens’ prescription opioid misuse — if it was current (in the 30 days preceding the survey), in the past or never — affected its link to suicidality.
About 7.4% of students reported that they had misused prescription opioids at least once before, while 7.2% reported misuse once or more within the last month.
“There are a number of factors that place youth at risk for misusing prescription opioids,” said lead study author Natalie Wilkins, a behavioral scientist in the CDC’s Division of Adolescent and School Health, via email. “Developmentally, adolescents’ brains have not yet fully matured which makes them more susceptible to engaging in risky and impulsive behaviors, such as substance use.”
The researchers found that current misuse of prescription opioids — compared to misuse in the past or never — was more significantly associated with seriously considering attempting suicide, making suicide plans and feeling sad or hopeless in the last year. Nearly 33% of students who reported current prescription opioid misuse actually attempted suicide, compared to 19% of teens who reported misuse in the past and 6% of students who said they had never misused an opioid prescription.
Why students turn to opioids
The study examined the associations between prescription opioid misuse, suicidality and symptoms of depression. Whether prescription opioid misuse can lead to suicidality and depressive symptoms or vice versa isn’t yet fully known. The authors also noted that one limitation of the study was that they didn’t know the levels of students’ misuse, such as whether they occasionally misused or had an opioid disorder.
Regardless, why teens start misusing opioids is a “nuanced and layered thing,” said Dr. Lucien Gonzalez, the chair of the American Academy of Pediatrics Committee on Substance Use and Prevention, who wasn’t involved in the study.
Misuse could stem from relieving physical pain from a medical procedure, curiosity, socializing or succumbing to peer pressure, Gonzalez said. Some teens may misuse to ease tension, emotional pain, mental issues or suicidal thoughts; or they may want to feel the euphoric high they’ve heard about from others.
Regarding the association with suicidality, substances including opioids and alcohol can reduce inhibitions, said Gonzalez, who is also an assistant professor in the department of psychiatry and behavioral sciences at the University of Minnesota’s medical school. That can make some people less likely to stop themselves from completing suicide ideation or an attempt.
Disparities among minorities
There were glaring disparities among different students: More female; Black; Hispanic; and lesbian, gay, bisexual or unsure teens currently misused prescription opioids than male and White teens. Some of the minority groups also had higher rates of feeling suicidal, sad or hopeless compared to the rates for male and White youth. And differences between heterosexual students and lesbian, gay, bisexual and unsure teens were extreme — 23.9% of lesbian, gay or bisexual students and 14.5% of unsure students attempted suicide, compared to 6.4% of heterosexual teens. Twelve percent of lesbian, gay or bisexual teens and 11.5% of unsure teens reported current misuse of prescription opioids, compared to 6.4% of heterosexual students.
The greater risks that lesbian, gay, bisexual and unsure teens face isn’t directly caused by their sexuality, but by how some people treat them because of it, Green said. “They are much more likely to experience discrimination, victimization (and) stigma due to their identity,” said Green, who is also an assistant adjunct professor at the University of California, San Diego. Green wasn’t involved in the study.
“Those experiences lead to these feelings of internalized shame, stigma, depression, which tend to result in things like thoughts of suicide, misuse of prescription medications — including opioids — to try to address the pain and suffering that they’re feeling,” Green said.
“When LGBTQ youth are supported and affirmed in their identities, when they have schools that are LGBTQ-affirming and they have parents that accept them, they are significantly at lower risk for actually considering and attempting suicide,” she added.
White students more commonly reported past prescription opioid misuse, seriously considering suicide and making a suicide plan than students of other races or ethnicities. But fewer White students reported suicide attempts.
Safety and healing from prescription opioid misuse
“Because kids can very quickly go from ideation to acting,” parents should create a safe environment around children and teens who may have suicidal thoughts, Gonzalez said.
Signs that could be indicative of substance misuse or another problem include the following, according to Gonzalez:
- Constricted pupils
- Slurred speech
- Shallow and short breathing
- Uncharacteristic mood or mood swings (tired, unusually calm, increasing or decreasing depression or anxiety)
- Track marks on skin or fresh puncture wounds
- Weight changes (often loss)
- Changes in friend groups
- Difficulty communicating
- Lack of motivation
- Changes in school attendance and/or performance
- Aggressive behavior
- Uncharacteristic disobedience
- Changes in appearance
- Lower energy levels (or maybe unusually higher)
- Evidence of drug paraphernalia
Given the common reasons behind opioid misuse, the manner in which we keep students “from being in that pain” is crucial, Green said.
Parents should take any concerns to their child’s pediatrician or take their child to a behavioral health clinician if the child is willing, Gonzalez said.
“It does start with talking to their kid, and it doesn’t even have to just start with, ‘I’m worried about drugs.’ It’s ‘I’m worried about you. Are you OK?'” he added.
If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the National Suicide Prevention Lifeline at 1-800-273-8255 to connect with a trained counselor or visit the NSPL site.
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