High schoolers who misuse prescription opioids are at higher risk for suicidal

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.

Some people dislike how opioids make them feel after surgeries. For others, the initial intention may have been harmless, but addiction is happening when casual use turns into using opioids “because they feel really bad when they don’t,” said Amy Green, a clinical psychologist and the vice president of research at The Trevor Project, a suicide prevention and crisis intervention organization for LGBTQ youth. “That can also cause a lot of struggling and suffering and feeling trapped, that they’re trapped in between the wanting to not use it and really struggling.”

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.