High schoolers who misuse prescription opioids are at higher risk for suicidal behaviors, study finds

Pictured are tablets of opioid painkiller Oxycodon delivered on medical prescription. A new study has examined associations between prescription opioid misuse and suicidal behavior among teens.

(CNN)About one of every three high school students who said they were misusing prescription opioids when they were surveyed reported they had attempted suicide, according to a study published Monday in the journal Pediatrics.

Previously, researchers have reported that young people who had misused prescription opioids at any point were at higher risk for suicidality, which the American Psychological Association defines as the "risk of suicide, usually indicated by suicidal ideation or intent" and a detailed plan to carry it out.
Authors of the new study investigated whether the timing of teens' prescription opioid misuse — if it was current (in the 30 days preceding the survey), in the past or never — affected its link to suicidality.
    The study used data from more than 13,600 US high schoolers' responses in the 2019 Youth Risk Behavior Survey from the US Centers for Disease Control and Prevention. The students answered questions about when and how often they had taken specific opioid pain relievers either without a prescription or differently from how their doctors had directed. The teens also reported whether and how many times they had seriously considered attempting, planned or actually attempted suicide in the past year.
      About 7.4% of students reported that they had misused prescription opioids at least once before, while 7.2% reported misuse once or more within the last month.
        "There are a number of factors that place youth at risk for misusing prescription opioids," said lead study author Natalie Wilkins, a behavioral scientist in the CDC's Division of Adolescent and School Health, via email. "Developmentally, adolescents' brains have not yet fully matured which makes them more susceptible to engaging in risky and impulsive behaviors, such as substance use."
        The researchers found that current misuse of prescription opioids — compared to misuse in the past or never — was more significantly associated with seriously considering attempting suicide, making suicide plans and feeling sad or hopeless in the last year. Nearly 33% of students who reported current prescription opioid misuse actually attempted suicide, compared to 19% of teens who reported misuse in the past and 6% of students who said they had never misused an opioid prescription.

          Why students turn to opioids

          The study examined the associations between prescription opioid misuse, suicidality and symptoms of depression. Whether prescription opioid misuse can lead to suicidality and depressive symptoms or vice versa isn't yet fully known. The authors also noted that one limitation of the study was that they didn't know the levels of students' misuse, such as whether they occasionally misused or had an opioid disorder.
          Regardless, why teens start misusing opioids is a "nuanced and layered thing," said Dr. Lucien Gonzalez, the chair of the American Academy of Pediatrics Committee on Substance Use and Prevention, who wasn't involved in the study.
          Misuse could stem from relieving physical pain from a medical procedure, curiosity, socializing or succumbing to peer pressure, Gonzalez said. Some teens may misuse to ease tension, emotional pain, mental issues or suicidal thoughts; or they may want to feel the euphoric high they've heard about from others.
          Addicted? How to get help

          If you're addicted to prescription drugs, help is available. You can call the Substance Abuse Mental Health Services Administration 24/7 hotline at 1-800-662-HELP(4357) or visit their website.

          Some people dislike how opioids make them feel after surgeries. For others, the initial intention may have been harmless, but addiction is happening when casual use turns into using opioids "because they feel really bad when they don't," said Amy Green, a clinical psychologist and the vice president of research at The Trevor Project, a suicide prevention and crisis intervention organization for LGBTQ youth. "That can also cause a lot of struggling and suffering and feeling trapped, that they're trapped in between the wanting to not use it and really struggling."
          Regarding the association with suicidality, substances including opioids and alcohol can reduce inhibitions, said Gonzalez, who is also an assistant professor in the department of psychiatry and behavioral sciences at the University of Minnesota's medical school. That can make some people less likely to stop themselves from completing suicide ideation or an attempt.

          Disparities among minorities

          There were glaring disparities among different students: More female; Black; Hispanic; and lesbian, gay, bisexual or unsure teens currently misused prescription opioids than male and White teens. Some of the minority groups also had higher rates of feeling suicidal, sad or hopeless compared to the rates for male and White youth. And differences between heterosexual students and lesbian, gay, bisexual and unsure teens were extreme — 23.9% of lesbian, gay or bisexual students and 14.5% of unsure students attempted suicide, compared to 6.4% of heterosexual teens. Twelve percent of lesbian, gay or bisexual teens and 11.5% of unsure teens reported current misuse of prescription opioids, compared to 6.4% of heterosexual students.