Opioid Overdose Survivors Report Having Had Suicidal Motivations

A research team at McLean Hospital found suicidal motivations are common just prior to nonfatal opioid overdose and occur along a continuum of severity

September 15, 2023

Past studies found that motivation for suicide may contribute to opioid overdose deaths in people with opioid use disorder (OUD).

In 2019, a research team at McLean Hospital found suicidal motivations are common just prior to nonfatal opioid overdose and occur along a continuum of severity.

Hilary S. Connery, MD, PhD, clinical director of McLean’s Division of Alcohol, Drugs, and Addiction, R. Kathryn McHugh, PhD, McLean’s chief of psychology and director of the Stress, Anxiety, and Substance Use Laboratory, and colleagues recently replicated and extended those findings in a study published in Drug and Alcohol Dependence.


The study setting was an inpatient unit at McLean for managing withdrawal from substance use.

Between June 2017 and March 2020, the researchers identified 60 adults who reported a history of opioid overdose and consented to complete self-report measures about their history of opioid use and overdoses, beliefs about the likelihood of overdose, and thoughts about death from overdose.

The mean number of overdoses was 4.5. The most recent overdose occurred within the past year for 48% of patients and within the past month for 20%.

Patient talking to clinician


Participant ratings of desire to die and intention to die suggested that these are dimensional factors, not binary factors, with the full range from none to high represented:

Question: “Just before your most recent overdose, how likely did you think it was that you would overdose?”

  • No chance (rating of 0 on a 0-10 scale)—39% of participants
  • High likelihood (rating ≥7)—14%
  • Mean rating—2.4

Question: “Just before your most recent opioid overdose, how strongly did you want to die?”

  • Did not want to die (rating of 0 on a 0-10 scale)—54%
  • Some desire to die (rating ≥1)—46%
  • Strong desire to die (rating ≥7)—19%
  • Mean rating—2.7

Question: “At the time of your most recent overdose, were you trying to kill yourself?”

  • No intention (rating of 0 on a 0-10 scale)—80.4%
  • Mild intention (rating of 1-3)—8.9%
  • Moderate intention (rating of 4-6)—5.3%
  • Strong intention (rating >7)—5.3%
  • Mean rating—0.9

14 of 34 participants who perceived some risk of overdose reported neither intent nor desire to die.


Correlations between the three factors (perceived likelihood of overdose, desire to die, and intention to die) were in the range of a medium effect size.

Reports of intention to die and desire to die were not redundant, suggesting that solely assessing intention to die is insufficient to detect potentially clinically relevant suicidal thinking.

Patients With OUD Need Interventions for Suicide Prevention

To amplify efforts to reduce fatal and nonfatal opioid overdoses, care for patients with OUD should include:

  • Universal suicide prevention screening
  • Suicide prevention education
  • Personalized safety planning, including attention to underestimation of overdose risk

These measures may be particularly important for times of crisis, such as the COVID-19 pandemic, when emergency department visits surged for both suicide attempts and drug overdoses.

Looking for mental health care for someone struggling with substance addiction? Call us today at 617.855.3141 to refer a patient.

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