Opiate Use and Rise in U.S. Suicide Rates: a Network Analysis Approach on the National Violent Death Reporting System Data

Suicide is a serious public health threat in the U.S. as evidenced by increases in suicide rates between 1999 and 2018 and between 2020 and 2022. Opiate use has been implicated as a contributor of such trends in suicide rates by directly influencing overdose deaths and indirectly by exacerbating mental health and life circumstances. A moderated network model was estimated on a subset of the National Violent Death Reporting System Data (n = 78,089) to examine the partial correlation structure of suicidal thoughts and behaviors, opiate use at the time of death, stressful life circumstances, experience of depression, alcohol abuse, and substance abuse. Moderation effects of year of death and opiate use at the time of death were independently tested to compare network structures across suicide decedent cohorts/years and opiate use at the time of death. Results showed that overall network structures appeared to be very stable over years/cohorts. Opiate use at the time of death, stressful life circumstances, experience of depression, alcohol abuse, and substance abuse explained limited variance of suicidal thoughts and behaviors. Simultaneously, connections between suicidal thoughts and behaviors, as well as depressed mood, increasingly strengthened over years/cohorts. Alcohol and substance abuse were also increasingly co-occurring over years/cohorts, although they were less co-occurring in decedents who had used opiates at the time of death. Future studies should aim to examine if partial correlation structures identified in the current study generalize in non-decedents and in those with marginalized identities.