Suicidality Among Adolescent Opioid Users: Individual, Interpersonal, and Community Level Risk and Protective Factors

Background and Purpose: Suicide among adolescents in the United States is a pressing public health concern. Growing evidence supports that opioid use is associated with increased suicidality among adolescents, potentially due to the neurobiological and behavioral impacts of opioid use during this critical development period. While prior research has explored risk and protective factors related to suicidality in the general adolescent population, few studies have specifically focused on adolescents who use opioids. This study aims to examine how perceived individual, familial, peer, school, and community-level experiences are associated with suicidality—both ideation and planning—among Adolescent Opioid Users (AOU).

Methods: We used data from the 2021-2023 National Survey on Drug Use and Health (NSDUH). We restricted our sample to adolescents aged 12 to 17 who reported past-year opioid use. The outcome variable was past-year suicidality, categorized into three groups: (1) no suicidal thoughts or plans, (2) suicidal thoughts only, and (3) suicidal plans (who had suicidal thoughts and plans). Independent variables included youth experiences across several domains: parental connection, peer experience, school and faith-based involvement, community engagement, aggression and depression, and demographics. Multinomial logistic regression was used to assess associations between these predictors and suicidality outcomes. Analyses were weighted to adjust for the complex sampling design.

Results: Our final analytic sample included 4,748 AOU. Among the 4,748 AOU, 78.9% reported no suicidal thought or plan in the past year, while 9.7% reported suicidal thoughts only, and 11.4% reported suicidal plans. In terms of racial composition, 44% of AOU were White, 26% were Hispanic, and 16% were Black. Several predictors were significantly associated with both suicidal thoughts and suicidal plans. AOU who talked to a parent or guardian about serious problems were less likely to experience either form of suicidality. In contrast, those who had no one to talk to, or argued frequently with parents, especially those who reported ten or more arguments, were more likely to report suicidal thoughts and plans. Past-year depression, history of criminal justice, and lower self-reported health were also significantly associated with increased suicidal thoughts and suicidal plans. Female AOU were more likely than males to report both outcomes. AOU who participated in one or two faith-based activities were less likely to report suicidal ideation, while those who reported attacking someone in the past year were more likely to report suicidal plans.

Conclusion and Implications: This study has several implications for designing prevention strategies for AOU. School and community-based programs that strengthen parent–child communication, expand access to youth mental health services, and incorporate trauma-informed practices within juvenile justice may be effective in reducing suicidality among AOU. Further research should examine how each risk and protective factor relates to suicidality in this population and explore how culturally and contextually responsive supports can mitigate these risks. Longitudinal studies are also needed to understand how early behaviors across these domains influence the development of suicidality among AOU.