Can small doses of opioids prevent suicides?

According to the 2015 report by Centers for Disease Control and Prevention (CDC), more than a million Americans attempted suicide in 2013 resulting in nearly 40,000 deaths. It has been identified as the 10th leading cause of death in the U.S. No particular medication is available as yet to provide relief from suicidal thoughts. Psychiatrists draw a distinction between depression and suicidal thoughts and they do not recommend prescribing antidepressants. Moreover, antidepressants may take weeks to start showing effects.

A 2016 study has found that a commonly used pain-relieving medicine could be a much-needed solution. Results of the study, which were published in the American Journal of Psychiatry, show that small doses of the opioid drug buprenorphine may be useful in controlling severely suicidal thoughts. As part of the study, one group of individuals was given small doses of buprenorphine and another group was administered a placebo. After a duration of two and four weeks, the researchers found a significantly lower incidence of suicidal thoughts in the first group as compared to the second group.

Although the study is one of the first to investigate this association, it indicates the possibility of buprenorphine becoming the first anti-suicide drug, provided future studies also report similar findings.

Suicidal thoughts are a result of psychological pain

American clinical psychologist Edwin S. Shneidman, co-founder of the Los Angeles Suicide Prevention Center, did extensive research on the subject. He highlighted the fact that suicidal thoughts arise due to psychological pain, or “psychache,” as he called it. According to him, psychache can comprise many feelings: hurt, anguish, soreness and psychological pain. He emphasized that depression, guilt or other negative emotions do not directly lead to suicidal thoughts unless they result in acute psychological pain.

Past research has also shown that physical pain and emotional pain activate the same areas of the brain. Accordingly, there is a renewed interest in the concept of psychological pain, long after the hypothesis was first proposed by Shneidman. Just as physical pain can be treated, it may also be possible to treat emotional pain and reduce the probability of suicidal thoughts.

The study authors relied on the concept of separation distress which affects humans and animals. Separation from a loved one, on whom someone is physically and emotionally dependent, causes emotional anguish. This leads to a decrease in the level of natural opioids found in the brain, which causes psychological pain. The researchers wanted to study the effect of opioid drugs in treating emotional pain, and consequently, suicidal thoughts. They selected buprenorphine since it is a weaker opioid and is less hazardous in case of an overdose. The participants were administered extremely low doses of buprenorphine to minimize the chances of addiction.

Factors to be considered before using opioids for suicide prevention

Opioid medication has been frequently used to treat physical pain as well as depression. Past research shows that acetaminophen, a drug used to treat physical pain, is successful in reducing social pain as well. However, the authors caution that extensive research is needed to prove the effectiveness and safety of opioids in preventing suicidal thoughts. The regulatory environment in the U.S. will also have a strong bearing on the use of opioids in treating patients with suicidal tendencies. There are also questions on the right dosage to treat patients as well as related risks.

In a separate study investigating opioid use and suicides, it was found that higher doses of opioids were associated with an increased suicide risk. The present study does not prove that opioids treat emotional pain, but it does show the efficacy of buprenorphine in reducing suicidal thoughts.

If you or a loved one is battling any mental disorder or suicidal tendencies, get in touch with the 24/7 Mental Health Helpline to learn about the best mental health counseling programs in the U.S. that offer diagnostic assessment by certified medical practitioners. Call at our 24/7 helpline number 855-653-8178 or chat online with our experts for more information on mental health rehabilitation centers near you.