May 20, 2011 -- Evidence of the troubling increase in prescription drug abuse has reached hospital emergency rooms, which report increasing medication-related suicide attempts among women 50 and older.
From 2005 to 2009, suicide attempts in which drugs played some role rose from 11,235 to 16,757 among women ages 50 and up, a federal survey found. The increase, driven in part by the last of the Baby Boomers entering their sixth decade, provides a new example of the toll wrought by the nation's prescription painkiller epidemic. In 2009, 16 million Americans age 12 and up had taken a prescription pain reliever, tranquilizer, stimulant or sedative for non-medical reasons in the previous year, according to the National Survey on Drug Use and Health.
The trends involving women and suicide appeared in a Drug Abuse Warning Network (DAWN) report dated May 12, 2011, but released Thursday to coincide with a meeting of the public-private Action Alliance for Suicide Prevention. The report, prepared by the Substance Abuse and Mental Health Services Administration, wasn't limited to suicide attempts involving deliberate overdoses; its authors counted any suicide attempt in which drugs were involved, such as a woman slashing her wrists while smoking marijuana.
Among women of all ages, emergency hospital visits for attempted suicide involving alcohol or illicit drug use remained "relatively stable" from 2005 to 2009, but increased for particular drugs. Drilling deeper into the report reveals that:
ER visits for suicide attempts associated with women taking drugs intended to counter anxiety and insomnia rose 56 percent, from 32,426 to 50,548. Hospital visits for attempted suicides involving a class of anxiety drugs known as benzodiazepines rose 67 percent. Those involving alprazolam (Xanax) went up 74 percent. Hospital visits for suicide attempts in which the insomnia drug zolpidem (Ambien) played a role rose 158 percent, from 2,177 visits to 8,190 visits, for all women, but only were statistically significant among women 35 to 49.
ER visits for women's suicide attempts associated with pain relievers grew more than 30 percent, from 36,563 to 47,838. Suicide attempts involving narcotic pain relievers remained relatively stable overall, but climbed 67 percent among women who took hydrocodone (Vicodin), from 4,613 to 7,715. They soared 210 percent for suicide attempts involving oxycodone (Oxycontin), from 1,895 to 5,875. A closer analysis found statistically significant increases in ER visits for attempted suicide involving oxycodone for women 21 to 34, and attempted suicide involving hydrocodone for women 35 to 49. Those age ranges span the years during which women typically marry, have children, build careers and reach menopause, all of which can contribute to stress.
Adult addiction specialist Dr. Elizabeth F. Howell, a past president of the American Society of Addiction Medicine and associate professor of clinical psychiatry at the University of Utah School of Medicine in Salt Lake City, said the report findings reflected higher overall rates of prescription abuse and addiction. They weren't surprising, she said, because as doctors spend less time with their patients, they rely more on pharmaceutical treatments for physical and psychological problems.
"When you go to the physician, there's not as much time to talk to the doctor. If I'm not sleeping very well, the doctor is more likely to give me a prescription, rather than talk to me for 5 minutes about sleep hygiene," she said. "There are not as many psychiatrists as we need. Even suicidal patients have trouble getting to see a psychiatrist."
Primary Care Doctors Prescribing Meds for Problems Psychiatrists Once Handled
As a result, "many more primary care professionals are put in the position of prescribing for anxiety and depression," even when their patients have health insurance and the means to see a specialist. Patients initially prescribed powerful pain medications for sports injuries or after surgery may discover those drugs help them relax or sleep better and begin "self-medicating their psychiatric symptoms and not just the physical pain," Howell said.
Howell said she suspects that women in their 50s, who tend to suffer aged-related aches and pains and have problems stemming from hormonal changes, are complaining to their doctors about "things that may not sound totally like depression or anxiety." She said they leave with prescriptions for anti-anxiety drugs, painkillers or sleeping pills, when they might benefit more from therapy, antidepressants or in some cases, hormonal therapy.
With so many primary care doctors and specialists handing out so many powerful pills, it's little wonder that patients end up with more medications than they need in their medicine cabinets. "If you paid for it, you tend to hang onto it," Howell said. "And then if you become depressed or otherwise impulsively suicidal, you look at your medicine cabinet. Overdose is a very common way to try to attempt suicide."
Although statistics show men more likely to kill themselves than women, women are more frequently treated for attempted suicide, according to 2011 figures compiled by the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention. In 2009, there were more than 215,000 ER visits by women trying to hurt themselves and women accounted for 3 out of 5 ER visits for drug-related suicide attempts.
The DAWN report said hospital emergency rooms are key places to identify at-risk women and refer them for "appropriate mental health and social services" that address underlying anxiety, depression and domestic abuse, before they can succeed in ending their lives. But it said much of that intervention could also take place by having doctors "monitor the frequency of requested refills, assess medical need, and refer to mental health services when indicated."
"The steep rise in abuse of narcotic pain relievers by women is extremely dangerous and we are now seeing the result of this public health crisis in our emergency rooms," said SAMHSA Administrator Pamela S. Hyde, an attorney and former state mental health director. "Emergency rooms should not be the front line in our efforts to intervene."
Given that older women represent one of the fast-growing populations, and that pain and sleep disorders increasingly are treated with prescription drugs, report concluded by saying that "expanded research on women's aging issues and the potential use of these drugs as a method of, or influence on, suicide attempts is critical."