The Impact of Prescription Opioid Misuse and Comorbid Substance Use on Suicidal Behaviors Among US Young Adults

Background/Purpose: Suicide is the third leading cause of death among young adults in the US, with prescription opioid misuse (POM) recognized as a risk factor of suicidality. Despite reports of higher rates of POM among young adults, studies exploring the link between POM and suicidal behaviors among young adults remain limited. Even fewer studies have investigated the association between comorbid use of other substances alongside POM and their impact on suicidal behaviors. This is alarming, given that a large percentage of young adults engaging in POM reported previous or concurrent comorbid substance use. This paper aims to bridge this gap by investigating the role of POM and comorbid substance use in predicting suicidal ideation and suicide attempts among a nationally representative sample of young adults.

Methods: We utilized data from the 2015-2019 National Surveys on Drug Use and Health (N=69,204, ages 18-25) Public-Use Files, and focused on a sample of 38,378 young adults reporting POM or illicit substance use without abuse or dependence signs. We used a multivariable logistic regression to examine the relationship between POM, illicit drug use, and suicidal behavior, adjusting for demographics and psychological risk factors.

Results: Findings indicate a dose-response relationship between illicit drug use alongside POM and the risk of suicidal ideation and attempts. After controlling for key covariates, the combination of POM and three or more illicit drugs were at the greatest odds of suicidal ideation (OR = 2.57, 95% CI = 1.61 – 4.11, p < .001) and attempts (OR = 3.57, 95% CI = 1.89 – 6.76, p < .001) compared to those without POM or drug use.

Conclusions and Implications: POM, with or without illicit drug use, can indicate a high suicidality risk among young adults. These findings highlight the need for further research into the intersection between and impact of POM and comorbid substance use on suicidal behaviors and the development of targeted interventions to provide timely, developmentally appropriate treatment to prevent further harm.