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Perspectives in Disease Prevention and Health Promotion Suicide and Suicide Attempts by the Nonmedical Use of Drugs

For 1983, the Drug Abuse Warning Network (DAWN) was notified of 2,975 deaths attributed to drug abuse and 108,585 drug abuse incidents. Although it is not a population-based surveillance system, DAWN, sponsored by the National Institute on Drug Abuse, monitors nonmedical use of drugs through 76 medical examiner facilities and 760 emergency rooms (1).

Of the 2,975 deaths related to drug abuse, 1,097 (37%) were classified as suicides. Attempted suicides were reported for 42,294 (39%) of the drug abuse incidents. More than half (53%) of persons whose deaths were attributed to suicide by drug overdose were female; 67% of persons attempting suicide by drug overdose were female. Death by drug overdose occurred in an older age group than did suicide attempt by drug overdose: 71% of deaths were among persons older than 30 years, whereas approximately 40% of persons attempting suicide were older than 30 years.

Alcohol in combination with some other substance was most commonly used in both suicides and suicide attempts reported to DAWN (Table 1). Alcohol was involved in 21% of suicides and 20% of suicide attempts. Amitriptyline, a prescription antidepressant, was used in 16% of suicides but only 4% of suicide attempts. Reported by Div of Epidemiology and Statistical Analysis, National Institute on Drug Abuse, ADAMHA; Violence Epidemiology Br, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: DAWN is a large data base but is neither a representative sample nor a population-based registry. Therefore, rates for drug-related suicides and suicide attempts cannot be calculated, and generalizations based on DAWN data may not be valid. DAWN data complement vital statistics information for suicide and provide additional clarification of drug-related suicide attempts by listing specific substances ingested.

Nonmedical use of drugs is cited as the method most frequently used in suicide attempts (2). However, suicide by self-poisoning (International Classification of Diseases, 9th Revision, E950), which includes nonmedical use of drugs, is decreasing in frequency in the United States (3). Between 1970 and 1980, suicide by self-poisoning decreased from 17% to 11% of all suicides. The total number of suicides has increased during the same period (3).

The high frequency of aspirin and acetaminophen ingestion reported in suicide attempts underscores the availability of these nonprescription drugs. Among prescription drugs used, amitriptyline, seldom abused for psychic effects, was the most frequently mentioned prescription substance used for suicide in DAWN reporting. Persons committing suicide by amitriptyline overdose are likely to have been in treatment for depression; depression is a significant risk factor for suicide (4). Limiting the number of pills per prescription, writing only nonrefillable prescriptions, and scheduling frequent office visits to assess patient response and to inquire about suicidal thoughts may help reduce deaths from antidepressant overdose.


  1. National Institute on Drug Abuse. DAWN. Annual Data, 1983. Rockville, Maryland: National Institute on Drug Abuse, 1984. DHEW publication no. (ADM) 84-1353. (Statistical series; series 1, no. 3).

  2. Wexler L, Weissman MM, Kasl SV. Suicide attempts 1970-1975: updating a United States study and comparisons with international trends. Br J Psychiatry 1978;132:180-5.

  3. CDC. Suicide surveillance. Atlanta, Georgia: Centers for Disease Control, 1985.

  4. Egeland JA, Sussex JN. Suicide and family loading for affective disorders. JAMA 1985;254:915-8.

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