This study aimed to explore the prevalence of suicidal ideas and suicidal attempts in an opioid-dependent population before entering a treatment and rehabilitation program at the CIATM Methadone Center in San Juan, Puerto Rico. We found that the prevalence of positive responses for suicide ideation was doubled from 2015 (8.5%) to 2018 (17%) in participants in a voluntary program to treat opioid abuse. The prevalence of positive participants for attempts to commit suicide increased from 7.0% in 2015 to 12.4% in 2018.
Suicide, addiction, and psychiatric diagnosis have a close relationship and is well demonstrated in psychiatric and public health literature. More than 90% of patients presenting to the emergency department with suicidal ideation suffer from psychiatric diagnoses, have a substance abuse disorder, or both (8). Addiction frequently damages familial, professional, personal, and financial relationships, creating a dire cycle and increasing the risk of suicide.
In September 2017, Puerto Rico suffered a catastrophic natural disaster, which may be a variable impacting the increase of suicidal ideation and suicidal attempts observed in 2017 and 2018. Compared with 2016, the number of suicides in Puerto Rico 4 months after Hurricane Maria was 16% higher and 26% higher six months after the hurricane (9). There was an average of 19 suicides per month eight months before Hurricane Maria, which rose to an average of 25 suicides per month the three months following the hurricane (3). In 2018, a 6% decrease in suicides in the general population living in Puerto Rico compared to 2017 (3). Contrary, we observed an increase in suicide ideation and attempts in 2018 in opioid-dependent participants. These increased rates found in the opioid-dependent participants could be attributable to multiple exposures, risks, and challenges more prevalent in this population as food insecurity, violent encounters, and fewer economic resources.
Despite the increase in suicidal ideations and attempts, we noticed an increasing trend to search for help in support groups. Participation in support groups increases from 0.09% in 2015 to 4.20% in 2018. Support groups positively impact participants' self-efficacy, increased satisfaction with the treatment experience, reduced relapse rates, and increased retention in treatment (10). Support groups can provide a practical approach to help opioid-dependent participants strive to achieve and maintain recovery.
Since the use of opioids in suicides has been increasing over time, our findings emphasize the need for health care providers to assess suicidal risk in patients receiving methadone as treatment. This increase in suicide ideations and attempts in opioid-dependent participants looking for help is especially crucial in rehabilitation centers to target appropriate interventions, and management approaches to recognize those at risk and prevent suicide.
Our study has some limitations, such as that the retrospective data that was analyzed is from one methadone center (San Juan) out of six centers in Puerto Rico, and the data collected from the year 2018 was not from the entire year in contrast with the data from 2015, 2016, and 2017. Nevertheless, our data provide further evidence that suicide risk increases in the opioid drug-abusing population in Puerto Rico.