All of us who work in behavioral health know that the opioid epidemic is possibly the greatest challenge in healthcare today. However, the usual response to opioid overdoses—immediate treatment with Narcan and release—has proven to do little to reduce subsequent drug use or overdose. Recent proposals have suggested that treating drug overdoses like suicides may be one way to help prevent future overdoses and save drug users’ lives.
Drug overdoses kill more people each year than gun homicides and car crashes combined—a staggering 142 people per day die of overdose, two-thirds of them from opioids. From a population health perspective, this crisis has hit vulnerable populations particularly hard. Poverty, unemployment and the helplessness that go with them are closely tied to higher incidence of drug use. The National Bureau of Economic Research found that for every one point that a county’s unemployment rate increases the opioid overdose emergency department (ED) visit rate increases by 7.0% and the opioid overdose death rate rises by 3.6%.
In line with this, Princeton economists Anne Case and Sir Angus Deaton have called drug overdose deaths among people experiencing measurable economic and social deterioration “deaths of despair” alongside suicide and alcohol overdose. While the healthcare system doesn’t traditionally see drug overdose as a suicide attempt, arguably anyone who willfully uses a substance known to cause death does not have great regard for his or her own survival.
This begs the question: Why don’t we routinely treat drug overdoses as suicide attempts? When a person is determined to be an imminent danger to themselves or others—for example after an unsuccessful suicide attempt—they can be held as an inpatient without consent under a civil or involuntary commitment. Laws vary by state. The Treatment Advocacy Center has a helpful chart outlining each state’s standards.
Some states include drug overdoses in their involuntary commitment statutes, meaning that if a person arrives in the ED after overdosing on heroin, the hospital can admit them to a psych unit for treatment whether they want it or not. However, many others either explicitly exclude substance use from their involuntary commitment standards or don’t mention them at all.