Drug poisoning in the US

Information on drug poisoning suicide deaths in the US is not available at a very granular level. However, the following table¹ does give a breakdown of 2012 suicide drug poisoning deaths:

According to the CDC¹, 81% of intentional poisoning suicides were caused by drugs - both legal and illegal. The most commonly used drugs identified in drug-related suicides were psychoactive drugs, such as sedatives and antidepressants, followed by opiates and prescription pain medications¹. Self-harm poisoning was the leading cause of emergency department visits for intentional injury in 2010².

In 2011, it was estimated by SAMHSA³ that attempted suicide led to 228,366 emergency department (ED) visits. Almost all involved a prescription drug or over-the-counter medication. It is worth noting that with only 5,465 actually succeeding in suicide using drugs, it means there were 42 ED visits for every successful suicide. Sobering odds of success, and there are probably lots of attempts that don't even end up in hospital.

Most patients attempting drug-related suicide had some form of follow-up after their ED visit, with the outcomes of their ED visits as follows:

• 49% were admitted for inpatient hospital care (18.3% to an intensive or critical care unit [ICU]), 9% to a psychiatric unit, and 22% to other units including combination psychiatric/detox units)
   
• 25% were transferred to another health care facility for specialist treatment
   
• 7% were referred to detox/treatment
   
• 15% treated and discharged to home

Evidence suggests that alcohol had been ingested in around a third of people who died by suicide, and in 29% of those admitted to ED departments. In nearly two thirds of cases more than one drug was involved.

Pain relievers were found to be involved in 38% of drug-related suicide attempts. Narcotic pain relievers were involved in over a third of that number, and cetaminophen products were involved in just under a third.

Benzodiazepines (anti-anxiety drugs) were found to be involved in 29.3% of drug - related suicide attempts. Alprazolam (Xanax) and clonazepam each accounted for about a third.

Antidepressants appeared in 19.6% of visits. About half of those visits involved an SSRI antidepressant such as citalopram, sertraline, or fluoxetine. Trazodone, a SARI antidepressant, was involved in about a quarter.

Antipsychotics, as a whole, appeared in 12.9% of visits, with the vast majority being the newer types of atypical anti-psychotics e.g. Quetiapine.

The American Association of Poison Control Centers (AAPCC)⁴ publishes data on phone calls they receive into their 55 centers which are designed to track the incidence of poison exposure (both intentional and unintentional) nationally. In 2012 they recorded 2,873 deaths by poisons (itself some way short of the figures provided by US Department of Health and Human Services for suicide alone), and the table below shows the drugs that appeared most frequently as the cause of death by poisoning.

Top 25 substance categories associated with deaths reported by 55 U.S. Poison Centers 2012

It should be noted that these percentages from their source do not add up to 100% as they are only the top 25 causes. It should also be noted that the above figures each represent the number of mentions in cause of death, not number of deaths. Any one fatality may have had exposure to more than one substance. Indeed, consistent with data from SAMHSA, the breakdown of drugs shown for many of the fatalities reported by AAPCC showed more than one drug.