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New Study Highlights Underreporting of Suicide by Drug Intoxication in the United States


Suicide by drug intoxication in the United States is under-reported and misclassified, suggests a new study conducted by researcher, Dr. Ian Rockett of West Virginia University’s School of Public Health (Paul, 2018).

Death by drug intoxication in the United States has increased for ages 15-years and older by 275% from 7.81 deaths per 100,000 in 2000 to 20.07 in 2015 (Centers for Disease Control and Prevention, 2018). The suicide rate has risen, and though we have the data mentioned above available to us, researchers emphasize that the numbers could be higher—misclassification and underreporting of intoxication suicides may have skewed the figures and most drug related deaths are classified as accidents, making it impossible to properly collect statistical data (Rockett et al, 2018).

Researchers studied suicides and undetermined deaths in a population consisting of individuals aged 15-years and older in 17 states: Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia and Wisconsin (Rockett et al, 2018). Data from the 17 states was retrieved from the National Violent Death Reporting System (NVDRS) from 2011-2013. NVDRS is an incident-based surveillance system administered by the Centers for Disease Control. The system gathers data and information pertaining to suicide and other violent deaths through death certificates, law enforcement records, medical examiners and coroner records (Rockett et al, 2018).

The NVDRS found that suicide notes, prior suicide attempts or affective disorders were documented in less than one-third of suicides and one-quarter of undetermined deaths (Rockett et al, 2018). Prevalent gaps were observed more often among drug intoxication cases than gunshot and hanging cases; most gunshot/hanging cases were classified as suicide as compared to drug intoxication cases (Rockett et al, 2018).

Researchers studied documented suicides against undetermined suicides through the data collected by the NVDRS.  The data included individuals who died by suicide or an undetermined death and who had a history of alcohol use, drug use or mental diagnosis. Researchers then calculated the prevalence of documented affective disorders, suicide notes and past suicide attempts among suicide and undetermined cases (Rockett et al, 2018).

The outcome variable was suicides versus undetermined deaths and the individual level predictors were suicide notes, cause of injury/mechanism of death, suicide attempts and a history of affective disorders or mental health problems.  The researchers hypothesized the designation of suicide as the manner of death would be more likely when there was a gunshot/hanging/suffocation cause of injury, and documentation of suicide notes, suicide attempts or affective disorders versus drug intoxication (Rockett et al, 2018).

After analyzing the data researchers found that gunshot/hanging deaths were 41-times more likely than drug intoxication deaths to be classified as a suicide. Cases with suicide notes and prior suicide attempts or a prior diagnosis of depression or bipolar disorder were also classified as suicides. Researchers noted that the presence of a suicide notes, affective disorders or prior suicide attempts were classified as a suicide in cases of gunshot/hanging deaths, while undetermined deaths were predominantly caused by drug intoxication (Rockett et al, 2018). Missing information caused by a lack of evidence—suicide notes, prior suicide attempts or affective disorders—leads to an increase of misclassification of drug intoxication as accidents rather than suicide as the manner of death and thus results in under-reporting.

Lack of resources and no evidence such as a suicide note, or history of affective disorder are some of the reasons for increasing misclassification and underreporting of suicide by drug intoxication (Rockett et al, 2018). Due to no psychological or psychiatric documentation contributing to deaths in drug intoxication cases leads to underreporting. Additionally, the opioid epidemic in the United States makes it more difficult to account for suicide by drug use.

For more information on this topic read “Suicides by drugs in U.S. are undercounted, new study suggests.”


Centers for Diseases Control and Prevention. (2018). National Violent Death Reporting System. Retrieved from https://www.cdc.gov/violenceprevention/nvdrs/index.html

Paul, S. (2018). Suicides by drugs in U.S. are undercounted, new study suggests. Retrieved from http://newsroom.ucla.edu/releases/suicides-by-drugs-u-s-are-undercounted-new-study-suggests

Rockett, I.R., Caine, E.D., Connery, H.S., D’Onofrio, G., Gunnell, D.J., Miller, T.R., …Jia, H. (2018) Discerning. PLOS ONE. Online publication. https://doi.org/10.1371/journal.pone.0190200



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