Race/Ethnic Differences in Non-Medical Prescription Opioid Use and Suicide Among Adolescents

Background: Prescription opioids have been recognized as one of the leading causes of death in the US, and this coincides with the rise of suicides among adolescents. Opioids were the cause of death in 31.4% of suicides involving poisoning, and the rise in overdose deaths in recent decades has been attributed to the opioid epidemic. Among adolescents, the increase in prescription opioid use (NMPOU) was associated with calls to poison centers which highlighted the risks of suicidality for this population. Of concern, non-White adolescents have been highlighted in past research as having greater risks for suicide, yet there is little to no research which examined the complex relationship of race, opioids and suicidality for this population. This study aims to examine race/ethnic differences in NMPOU and suicidality among adolescents. It was hypothesized that among adolescents 1) NMPOU is associated with suicidality and 2) the relationship of NMPOU with suicidality is stronger for non-White young adult populations.

Methods: This study used data from the 2016 National Survey on Drug Use and Health. The sample included 11,489 non-Hispanic White, African American, Asian and non-White Hispanic adolescents aged 12 to 17. Weighted logistic regression analysis was used to examine the relationship of race/ethnicity in the relationship of NMPOU with 1) having serious thoughts of killing oneself, 2) made plans to kill oneself, and 3) attempted to kill oneself, all within the past year. Control variables included socio-demographics, other substance use, social factors and health and mental health.

Results: Analysis indicated that adolescents who engaged in NMPOU had higher prevalence of serious thoughts of suicide (31.0%), making a suicide plan (22.1%) and making a suicide attempt (17.9%) compared to non-users (thoughts: 9.8%; plan: 4.5%; attempt: 3.0%). The race/ethnic profile of users and non-users were statistically similar. When controlling for all other variables, NMPOU was associated with increased odds for making a suicide plan (OR = 1.68, p < 0.05). NMPOU was not significantly associated with thoughts of suicide and suicide attempts. Asian adolescents had the highest prevalence in the three measures of suicidality compared to all other race/ethnic groups, and had higher odds for having a suicide plan (OR = 1.62, p<0.01) and making a suicide attempt (OR = 1.94, p < 0.05). Furthermore, the interaction effect for Asian ethnicity and NMPOU was significant for having a suicide plan (OR = 4.95, p < 0.05) and making a suicide attempt (OR = 7.33, p < 0.05).

Conclusions: Findings suggest that NMPOU is associated with higher prevalence and odds of suicidality among adolescents. Although opioid misuse was similar across race/ethnic groups, Asian adolescents were disproportionately impacted by the effects of the opioid epidemic. Future research can examine the relationship of opioids, mental health, and engagement in mental health treatment for at-risk populations of adolescents, in particular with Asian young adults. Social workers can highlight the critical need for prevention and mental health treatment through advocacy and engagement to address this on-going public health issue.