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The Intersection of Opioids and Suicide:

A Prevention Approach

National Prevention Week Webinar

October 25, 2018 

Disclaimer: The views, opinions, and content expressed in this presentation do not necessarily reflect 

the views, opinions, or policies of the Center for Substance Abuse Prevention (CSAP), the Substance 

Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and 

Human Services (HHS).
Recording in Progress!

This meeting will be recorded for 

archiving purposes.

4
David Lamont Wilson 

NPW Coordinator, Public Affairs Specialist 

Center for Substance Abuse Prevention

Substance Abuse and Mental Health Services Administration
NPW 2019 Webinar Series

6

Month Webinar Topic

October 25, 2018 The Intersection of Opioids and Suicide: A Prevention Approach

November 15, 2018 Marketing Impact: How NPW Amplifies Community Prevention Programs, 

Campaigns, and Initiatives

December 2018 Prevention as a Profession: A Prevention Workforce Development Webinar

January 2019 Deploying Substance Use Prevention in Military Communities

February 2019 Teens and Vaping Prevention

March 2019 Opioid Use Prevention and Older Adults

April 2019 Tips for Teens: Engaging Teens in Substance Use Prevention

May 2019 Communities Talk: Town Hall Meeting to Prevent Underage Drinking 

Albuquerque, New Mexico (webcast)
Today’s Presenters

• Richard T. McKeon, Ph.D., MPH, Chief, Suicide Prevention 

Branch, SAMHSA

• Kristen Quinlan, Ph.D., Epidemiologist, SAMHSA’s Suicide 

Prevention Resource Center (SPRC)

• Kerri Smith Nickerson, LCSW, MPH, Director, Grantee and 

State Initiatives, SPRC

• Kelley Cunningham, Director, Suicide Prevention Program, 

Massachusetts Department of Public Health

7
NPW 2019

8
• To involve communities in raising 

awareness of behavioral health issues and 

in implementing prevention strategies, and 

showcasing effectiveness of evidencebased prevention programs.

• To foster partnerships and collaboration

with federal agencies and national 

organizations dedicated to behavioral and 

public health.

• To promote and disseminate quality 

behavioral health resources and 

publications.

NPW Goals

9
Available NOW! NPW 2018 Outcomes Report

Visit www.samhsa.gov/prevention-week to view and share 10
NPW 2019 Daily Health Themes

Monday, May 13 Prevention of Prescription & Opioid Drug 

Misuse

Tuesday, May 14 Prevention of Underage Drinking & 

Alcohol Misuse

Wednesday, May 15 Prevention of Illicit Drug Use & Youth 

Marijuana Use

Thursday, May 16 Prevention of Youth Tobacco Use

Friday, May 17 Prevention of Suicide

11
Have NPW Plans? Tell Us

Get more exposure for your NPW activity!

• Submit event details through the NPW 

website and we’ll help promote it. 

• Visit the NPW website’s “Event 

Submission Form” page: 

samhsa.gov/prevention-week/communityevents/submit-events

• Bookmark the page! 

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Stay Connected: Sign Up for Prevention Works!

Visit www.samhsa.gov/prevention-week

• Sign up for Prevention Works emails

• Receive emails throughout the year 

featuring the latest prevention 

resources, NPW news, and 

prevention strategies and ideas to 

strengthen your work in the field

13
Prevention Every Day

14
Richard T. McKeon, Ph.D., MPH 

Suicide Prevention Branch Chief

Center for Mental Health Services

Substance Abuse and Mental Health Services Administration
•Suicide, Substance Use, and Opioids: Opportunities for 

Prevention 

Richard McKeon, Ph.D., Chief, Suicide Prevention Branch

SAMHSA

National Prevention Week Webinar
Disclaimer

The views, opinions, and content expressed in 

this presentation do not necessarily reflect the 

views, opinions, or policies of the Center for 

Mental Health Services, the Substance Abuse 

and Mental Health Services Administration 

(SAMHSA), or the U.S. Department of Health 

and Human Services.
National Center for Injury Prevention and Control

Division of Violence Prevention

CDC Vital Signs:Suicide rising across the U.S. 

More than a mental health concern

Deborah M. Stone, ScD, MSW, MPH

Behavioral Scientist June 12, 2018 18
PROBLEM SUICIDE RATES INCREASED 

IN ALMOST EVERY STATE.

Suicide rates rose across the US

from 1999 to 2016.

Increase 38 - 58%

Increase 31 - 37%

Increase 19 - 30%

Increase 6 - 18%

Decrease 1%

SOURCE: CDC’s National Vital Statistics System; 

CDC Vital Signs, June 2018.

19
45K

5544%%

Nearly 45,000 lives lost

to suicide in 2016.

Suicide rates went up 

more than 30 percent in

half of states since 1999.

More than half of people

who died by suicide did 

not have a known mental 

health condition.

30%

RESULTS

20
Percentage increases in state suicide rates 

Top 10

21
Statistics

22
23

Leading causes of death for selected age groups–United 

States, 2016

Rank 10-14 years 15-19 years 20-29 years 30-39 years 40-49 years 50-59 years

1 Unintentional

Injuries

Unintentional

Injuries

Unintentional

Injuries

Unintentional

Injuries

Unintentional

Injuries

Malignant

Neoplasms

2 Suicide Suicide Suicide Suicide Malignant

Neoplasms

Heart 

Disease

3 Malignant

Neoplasms

Homicide Homicide Malignant

Neoplasms

Heart 

Disease

Unintentional

Injuries

4 Homicide Malignant

Neoplasms

Malignant

Neoplasms

Heart 

Disease

Suicide Liver

Disease

5 Congenital

Malformations

Heart 

Disease

Heart 

Disease

Homicide Liver

Disease

Chronic Lower 

Respiratory Ds 

6 Heart 

Disease

Congenital

Malformations

Diabetes

Mellitus

Liver Disease Diabetes

Mellitus

Diabetes

Mellitus

7 Chronic Lower 

Respiratory Ds

Chronic Lower 

Respiratory Ds

Congenital

Malformations

Diabetes

Mellitus

CerebroVascular

Suicide

8 CerebroVascularCerebroVascularComplicated 

pregnancy

CerebroVascularHomicide CerebroVascular

Source: CDC vital statistics
24

0

50

100

150

200

250

300

350

400

450

500

550

600

650

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-64 65+

Age Group in years Rate per 100,000 population Males

Females

Self-inflicted injury among all persons by age and sex–

United States, 2015

Source: CDC WISQARS NEISS
25

Suicidal Thoughts, Plans, and Attempts in the Past Year among 

Adults Aged 18 or Older: Numbers in Millions, 2017

FFR1.58
26

+ Difference between this 

estimate and the 2017 

estimate is statistically 

significant at the .05 level. 

Suicidal Thoughts in the Past Year among Adults Aged 18 or Older, 

by Age Group: Percentages, 2008-2017

FFR1.59

Age Group 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

18 or Older 3.7+ 3.7+ 3.8+ 3.7+ 3.9+ 3.9+ 3.9+ 4.0 4.0 4.3

18 to 25 6.8+ 6.1+ 6.7+ 6.8+ 7.2+ 7.4+ 7.5+ 8.3+ 8.8+ 10.5

26 to 49 4.0 4.3 4.1 3.7+ 4.2 4.0 4.0 4.1 4.2 4.3

50 or Older 2.3 2.3 2.6 2.6 2.4 2.7 2.7 2.6 2.4 2.5
27

+ Difference between this 

estimate and the 2017 

estimate is statistically 

significant at the .05 level. 

Suicide Plans in the Past Year among Adults Aged 18 or Older, by 

Age Group: Percentages, 2008-2017

FFR1.60

Age Group 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

18 or Older 1.0+ 1.0+ 1.1+ 1.0+ 1.1 1.1 1.1+ 1.1+ 1.1+ 1.3

18 to 25 2.0+ 2.0+ 1.9+ 1.9+ 2.4+ 2.5+ 2.3+ 2.7+ 2.9+ 3.7

26 to 49 1.1 1.0 1.0 1.1 1.3 1.3 1.1 1.1 1.3 1.2

50 or Older 0.7 0.6 0.9 0.7 0.6 0.6 0.7 0.7 0.5 0.6
28

+ Difference between this 

estimate and the 2017 

estimate is statistically 

significant at the .05 level. 

Suicide Attempts in the Past Year among Adults Aged 18 or Older, 

by Age Group: Percentages, 2008-2017

FFR1.61

Age Group 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

18 or Older 0.5 0.5 0.5 0.5 0.6 0.6 0.5+ 0.6 0.5 0.6

18 to 25 1.2+ 1.1+ 1.2+ 1.2+ 1.5+ 1.3+ 1.2+ 1.6 1.8 1.9

26 to 49 0.4 0.5 0.4 0.5 0.5 0.6 0.5 0.5 0.5 0.4

50 or Older 0.3 0.2 0.3 0.3 0.3 0.3 0.3 0.3 0.2 0.3
Data Sources:

A. CDC WISQARS 2016

B. CDC WONDER 2014

C. Bureau of Justice Statistics 2014

D. DoDSER CY 2016 Q1-4 Reports

E. Department of Veterans Affairs 2016

F. Luoma et al, 2002; Ahmedani et al 2014

G. Ahmedani, 2018. Personal communication

H. CDC WISQARS 2016

I. CDC WISQARS 2016

Identifying Areas of High Need and/or Opportunity

Firearm 

Deaths 

22,938A

Seen in ED

for 

any reason

in past year

21,583G

Vehicle 

emissions 

Poisoning

~ 791B

Accessed 

healthcare 

within 30 

days of 

death

~ 20,000F

Inmates

621C

Military 

466D

________________

Veterans

~7,300 Youth E

Under 18

2,023H

Age 50+

20,532I

44,965 annual suicide decedents

Age 18-25

580,000A

Outpatient 

MH 

Treatment*

410,000A

Military

?C

SU 

Treatment*

110,000A

Parole*

28,000A

________________

Probation*

79,000A

Age 50+

210,000A

College: 

Full Time

90,000A

____________

Part time

52,000A

Veterans

?B

Data Sources:

A. National Survey on Drug Use and Health

B. In progress

C. In progress

* Last 12 months

1.3 million annual suicide attempts
Substance Use and Suicide

• Data from 17 states NVDRS

• 22% of suicides involve alcohol intoxication, (30-40% of suicide 

attempts)

• Opiates, including heroin and prescription painkillers present in 20% of 

U.S. suicide deaths.

• Marijuana-10%,cocaine-4%,amphetamines-3%
SUICIDE AND SUBSTANCE ABUSE

• Substance abuse is second only to mood disorders 

in its association with suicide

• Comorbidity increases the risk even further

• Suicide mortality can be impacted by changes in 

alcohol control policy

• Drinking age increase associated with decreased 

mortality-estimate 600 lives saved annually
HOMICIDE

MVAs & 

Accidental 

Poisoning

Suicide

Emerging Behavioral Problems & 

Mental Health Disturbances

School Difficulties

Alcohol and Substance Misuse

Legal System Involvements

Emergency Room Visits

Mental Health & Chemical Dependency Treatment Contacts

Common Risk Factors for Premature Death

Disruptive Family Factors

Disadvantaged Economic & Social Factors

Indicated & Clinical 

Selective

& Indicated 

Universal &

Selective 

Prevention & Intervention

Opportunities 
The Garrett Lee Smith (GLS) Suicide Prevention National Outcomes Evaluation is supported through contract no. HHSS283201200007I/HHSS28342002T (reference no. 283-12-0702) awarded to ICF International 

by the Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), US Department of Health and Human Services (HHS).

THE IMPACT OF GLS SUICIDE PREVENTION 

PROGRAM ON YOUTH SUICIDAL BEHAVIOR

Lucas Godoy Garraza (ICF International); Christine 

Walrath (ICF International); David Goldston (Duke CSSPI); 

Hailey Reid (ICF International), Richard McKeon 

(SAMHSA)
Results: Difference in Suicide Mortality

GLS implementation GLS + 1 year GLS + 2 years GLS implementation GLS + 

1 year GLS + 2 years

Solid lines represent the estimated outcome trajectory following GLS training implementation. 

Dashed lines represent the estimated outcome trajectory during the same period had GLS not 

been implemented. 90% and 50% confidence intervals around the trajectory are represented 

by dark gray and light gray, respectively.

count per 100,00

0

6

7

8

9 10 11 12

Training year (T) T + 1 year T + 2 years Training year (T) T + 1 year T + 2 years count per 100,00

0

14 16 18 20 22 24

Suicide 10-24 Suicide 25+
©2015-2017 EDC, Inc. All Rights Reserved. 35

A System-Wide Approach Saved Lives: 

Henry Ford Health System
Education Development Center Inc. ©2015 All Rights Reserved.

36 THE TOOLS OF ZERO SUICIDE FILL THE GAPS
Risk following completion of PHQ9

(sample size = 1.2 million)


Education Development Center Inc. ©2015 All Rights Reserved.

40

Resource: Safety Planning Intervention

Access at: www.zerosuicide.com 
Assessing and Managing Suicide Risk

http://www.sprc.org/training-events/amsr
TIP 50

TIP 50: Addressing Suicidal Thoughts and Behaviors in Substance Abuse 

Treatment

• High prevalence of suicidal thoughts and attempts among persons with SA 

problems who are in treatment.

• TIP 50 helps

▪ SA counselors work with adult clients who may be suicidal

▪ Clinical supervisors and administrators 

• Free at: http://store.samhsa.gov/product/SMA09-4381

• Training video: SAMHSA YouTube channel

• SPRC Webinar: https://www.sprc.org/events-trainings/tip-50-addressingsuicidal-thoughts-behaviors-substance-abuse-treatment
Suicide Assessment Five-Step Evaluation Triage 
Suicide Prevention App for Health Care Providers

Learn more at bit.ly/suicide_safe.

Suicide Safe Helps Providers:

➢ Integrate suicide prevention strategies 

into practice and address suicide risk

➢ Learn how to use the SAFE-T approach

➢ Explore interactive sample case studies 

➢ Quickly access and share information 

and resources

➢ Browse conversation starters

➢ Locate treatment options

Free for Apple® and AndroidTM

mobile devices
Improving Post Discharge Safety

• The Emergency Department Safety Assessment and 

Follow-up Evaluation (ED-SAFE) demonstrated 

reduction in suicidal behavior for suicidal people 

discharged from EDs doing telephonic follow up.

• White Mountain Apache/Johns Hopkins University 

Center for American Indian Health

o Almost 40% reduction in suicides from 2006-2012

o Centerpiece is tribally mandated reporting and follow up 
Improving Post Discharge Safety

Safe-Vet-Safety planning in the Emergency Room for 

suicidal veterans combined with telephonic follow up 

led to:

• 50% reduction in suicidal behavior compared to tau

• Twice as many veterans connecting to outpatient 

behavioral health care

• SAMHSA evaluation studies show that 90% of 

suicidal callers report that follow up phone calls 

helped them stay safe and not kill themselves 

Mobile Crisis

Call Center Hub

Crisis Facilities

What is the Crisis 

Now model?

“Air Traffic Control” Crisis Call 

Center Hub Connects and 

Ensures Timely Access and 

Data
Ubiquitous and inexpensive technology is 

changing nearly every other industry. 

• Many opioid overdose deaths labeled as accidental may be suicides. Estimates differ.

• For some deaths may not be possible to determine intent.

• Non-fatal overdoses, whether intentional or not, may require similar responses (i.e. medical care 

for the overdose, assessment for suicide risk and substance abuse, and rapid follow up).

• How should suicide screening be best integrated into substance abuse screening?

• How can suicide care be best integrated into substance abuse treatment?

• How can we assist communities heavily impacted by both suicide and opioids?

• What is the impact of chronic and acute pain, opioids, and suicide?

• How can we alter the developmental trajectories that lead to both types of tragic outcomes?

• Are there common factors driving up these deaths of despair?

Suicide and Opioids: Critical Issues
Education Development Center Inc. ©2015 All Rights Reserved.

52

Thank you.

SAMHSA’s mission is to reduce the impact of substance 

abuse and mental illness on America’s communities.

Richard McKeon, Ph.D., M.P.H.

Branch Chief, Suicide Prevention, SAMHSA

240-276-1873

Richard.mckeon@samhsa.hhs.gov

www.samhsa.gov www.sprc.org
Kristen Quinlan, Ph.D. 

Lead Epidemiologist

SAMHSA’s Suicide Prevention Resource Center (SPRC)

Education Development Center, Inc.
www.sprc.org @SPRCTweets

Kristen Quinlan, PhD

Epidemiologist, Suicide Prevention Resource Center

Director of Outreach, Injury Control Research Center for Suicide Prevention

Understanding the Connection: 

Suicide and Opioid Misuse
www.sprc.org

SPRC | Suicide Prevention Resource Center

The Suicide Prevention Resource Center at EDC is supported by a grant from the U.S. Department 

of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration 

(SAMHSA), Center for Mental Health Services (CMHS), under Grant No. 5U79SM062297. 

The views, opinions, and content expressed in this product do not necessarily reflect the views, 

opinions, or policies of CMHS, SAMHSA, or HHS. 

55
www.sprc.org

SPRC | Suicide Prevention Resource Center

Highlight the connection between opioid abuse 

and suicide using epidemiological data.

Review the research explicitly studying this 

connection.

Identify the challenges facing the field in 

understanding the connection.

Review research on shared risk and protective 

factors as a space for intervention.

Objectives

56
www.sprc.org

SPRC | Suicide Prevention Resource Center

Prescription Drug Abuse and Suicidal Behaviors: Adults

3.0 2.9 3.2 3.2 3.2 3.3

8.0 9.3 8.8 8.4

10.5 10.8

0.0

15.0

30.0

2011 2012 2013 2014 2015 2016

 No Rx drug abuse Rx drug abuse 1+ time in lifetime

% Adults (18+) Who Report Having Serious Thoughts of Suicide in the Past Year by 

Lifetime Nonmedical Prescription Drug (including Opioid) Use (2011-2016)1

57
www.sprc.org

SPRC | Suicide Prevention Resource Center

Prescription Drug Abuse and Suicidal Behaviors: Youth

4.3 5.1 5.6 6.4

14.5

17.2 18.7 19.2

0.0

25.0

50.0

2009 2011 2013 2015

No Rx Drug Abuse Rx Drug Abuse 1+ Times in Lifetime

% Students (in Grades 9-12) Who Report Having Serious Thoughts of Suicide in 

the Past Year by Lifetime Prescription Drug (including Opioid) Abuse (2009-

2015)2

58
www.sprc.org

SPRC | Suicide Prevention Resource Center

From the Research...

• Adults who receive high doses of opioids 

are at increased risk for suicide3

• Adults who abuse opioids weekly or more 

are more likely to engage in suicide 

planning and attempts4

• Adults who have an opioid use disorder are 

13 times more likely to die by suicide than 

the general population5

59
www.sprc.org

SPRC | Suicide Prevention Resource Center

Opioids and Suicide: Three Possible Links

Higher doses of opioids offer increased access to lethal 

means.

Opioids have disinhibiting effects, increasing the likelihood 

of acting on suicidal impulses.

People who take higher opioid doses share other 

characteristics that explain the link with suicide.

60
www.sprc.org

SPRC | Suicide Prevention Resource Center

When classifying a death as a suicide, a coroner or ME has to determine 

two things:

1. Did the person know that the dose was likely to be lethal? 

2. What was the person’s intent?

This intent question is one of the most challenging aspects of our 

opioid/suicide death data. 

Limitations to Overdose and Suicide Death Data

Intentionality Continuum

61
www.sprc.org

SPRC | Suicide Prevention Resource Center

We are likely underestimating the number of opioid-related deaths that 

are actually suicides. And this matters because:

– This underestimation is not random–some groups are affected more 

than others.

– We use data for planning where we direct prevention efforts.

– We use data for evaluating the outcomes of our prevention efforts.

Implications for Practice

62
www.sprc.org

SPRC | Suicide Prevention Resource Center

Shared risk and protective factors for opioid 

abuse/overdose and suicide

Opioid Abuse/

Overdose

Suicidality

Intersection

Physical Health 

Problems6,7

Behavioral Health 

Problems7,8

Trauma/Adverse 

Childhood 

Experiences7,9

Social Isolation8,10

63
www.sprc.org @SPRCTweets

Kristen Quinlan, Ph.D.

Kquinlan@edc.org

EDC Headquarters

43 Foundry Avenue

Waltham, MA 02453

EDC Washington DC

1025 Thomas Jefferson Street, NW

Suite 700

Washington, DC 20007

edc.org

Thank you!
www.sprc.org

SPRC | Suicide Prevention Resource Center

References

1. Center for Behavioral Health Statistics and Quality. (2017). 2016 National Survey on Drug Use and Health. 

Substance Abuse and Mental Health Services Administration, Rockville, MD.

2. Centers for Disease Control and Prevention. (2009-2015).Youth Risk Behavior Survey Data. Available at: 

www.cdc.gov/yrbs. Accessed on April 20, 2018. 

3. Ilgen, M.A., Bohnert, A.S.B., Ganoczy, D., Bair, M.J., McCarthy, J.F., & Blow, F.C. (2016). Opioid dose and risk of 

suicide. Pain, 157(5), 1079-1084. https://www.slideshare.net/101N/opioid-dose-risk-of-suicide

4. Ashrafioun, L., Bishop, T.M., Conner, K.R., & Pigeon, W.R. (2017). Frequency of prescription opioid misuse and 

suicidal ideation, planning, and attempts. Journal of Psychiatric Research, 92, 1-7. 

5. Wilcox, H.C., Conner, K.R., & Caine, E.D. (2004). Association of alcohol and drug use disorders and completed 

suicide: an empirical review of cohort studies. Drug and Alcohol Dependence, 76 Suppl:S11-9.

6. Rosenblum, A., Parrino, M., Schnoll, S. H., Fong, C., Maxwell, C., Cleland, C. M., . . . Haddox, J. D. (2007). 

Prescription opioid abuse among enrollees into methadone maintenance treatment. Drug and Alcohol Dependence, 

90(1), 64–71

7. National Strategy for Suicide Prevention. (2012). 2012 National Strategy for Suicide Prevention: Goals and 

Objectives for Action: A Report of the U.S. Surgeon General and of the National Action Alliance for Suicide 

Prevention. https://www.ncbi.nlm.nih.gov/books/NBK109909/

8. Ford, J. A., & Rigg, K. K. (2015). Racial/Ethnic differences in factors that place adolescents at risk for prescription 

opioid misuse. Prevention Science: The Official Journal of the Society for Prevention Research, 16(5), 633–641.25 

9. Austin, A.E., Shanahan, M.E. (2018). Association of childhood abuse and neglect with prescription opioid misuse: 

Examination of mediation by adolescent depressive symptoms and pain. Children and Youth Services Review, 86, 

84-93. 

10. Fontanella, C.A., Hiance-Steelesmith, D.L., Phillips, G.S., et al.., (2015). Widening Rural-Urban Disparities in Youth 

Suicides, United States, 1996-2010. Journal of the American Medical Association, 169(5):466-473.

65
Kerri Smith Nickerson, LCSW, MPH 

Director of Grantee and State Initiatives

SAMHSA’s Suicide Prevention Resource Center (SPRC)

Education Development Center, Inc.

66
www.sprc.org @SPRCTweets

October 25, 2018

SAMHSA National Prevention Week Webinar

Opioids and Suicide: 

Opportunities for Collaboration

Kerri Nickerson, LCSW, MPH

Director, Grantee and State Initiatives

Suicide Prevention Resource Center
www.sprc.org

SPRC | Suicide Prevention Resource Center

The Suicide Prevention Resource Center at EDC is supported by a grant from the U.S. Department 

of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration 

(SAMHSA), Center for Mental Health Services (CMHS), under Grant No. 5U79SM062297. 

The views, opinions, and content expressed in this product do not necessarily reflect the views, 

opinions, or policies of CMHS, SAMHSA, or HHS. 

68
www.sprc.org

SPRC | Suicide Prevention Resource Center

Understanding the Scope of the Problem

• Identify community-level data sources to assess 

cause(s) of death

• Collect data on both method of suicide AND 

presence of opioids in suicidal attempts and deaths

• Compare local data to national and state data

• Identify potential partners who can contribute 

qualitative data

• Understand what populations are at increased risk 

for suicide and opioid abuse in your community 

69
www.sprc.org

SPRC | Suicide Prevention Resource Center

Example From the Field: Rhode Island

Key Features: Tests all suicide deaths (98% in 2017) 

for the presence of opioids, participates in a 20-state 

partnership to reduce opioid trafficking

Benefits of Collaboration: 

• Better informed prevention efforts due to 

comprehensive data

• Reductions in opioid supply www.preventoverdoseri.org

70
www.sprc.org

SPRC | Suicide Prevention Resource Center

Using Data to Determine Next Steps

Once you’ve identified who is being affected in your 

community...

• Identify shared risk and protective factors

• Consider relevant local conditions that may 

influence these problems

• Identify others in your region who are addressing 

this issue

71
www.sprc.org

SPRC | Suicide Prevention Resource Center

Example From the Field: Connecticut

Key Features: Implements strategies to reduce access to 

lethal means, addresses stigma around naloxone use, 

shares information on the detrimental impact of 

misclassification

Benefits of Collaboration: 

• Increased coordination

• Access to data

• Connections to survivors reduced stigma and informed 

practice

72
www.sprc.org

SPRC | Suicide Prevention Resource Center

Tapping into Existing Resources

73
www.sprc.org

SPRC | Suicide Prevention Resource Center

Tapping into Existing Resources

74
www.sprc.org

SPRC | Suicide Prevention Resource Center

Suicide Prevention Resource Center: 

www.sprc.org

• Archived webinars on link between opioids and 

suicide:

• https://go.edc.org/opioidwebinar1

• https://go.edc.org/opioidwebinar2

National Action Alliance for Suicide Prevention: 

www.actionallianceforsuicideprevention.org

Zero Suicide Toolkit: http://zerosuicide.sprc.org/

• Archived webinar on substance use and Zero 

Suicide: https://go.edc.org/ZSwebinar

Resources

Substance Abuse and Mental Health Services 

Administration: https://www.samhsa.gov

• In Brief: Substance Use and Suicide: 

https://store.samhsa.gov/product/In-BriefSubstance-Use-and-Suicide-/SMA16-4935

CDC Vital Signs Reports 

• Suicide:

https://www.cdc.gov/vitalsigns/suicide/index.

html

• Opioid Overdoses in EDs: 

https://www.cdc.gov/vitalsigns/opioidoverdoses/index.html

75
www.sprc.org @SPRCTweets

Kerri Nickerson, LCSW, MPH

knickerson@edc.org

EDC Headquarters

43 Foundry Avenue

Waltham, MA 02453

EDC Washington DC

1025 Thomas Jefferson Street, NW

Suite 700

Washington, DC 20007

edc.org 

Thank you!
Kelley Cunningham 

Suicide Prevention Program Director

Massachusetts Department of Public Health

77
Massachusetts Prevention Strategies:

The Intersection Between Opioids and Suicide

MA Department of Public Health

Division of Violence & Injury Prevention

Suicide Prevention Program

Kelley Cunningham

MA Department of Public Health

Division of Violence & Injury Prevention

Suicide Prevention Unit

78
Source: MA Violent Death Reporting System, MA Department of Public Health

MA Data – Suicides

468 455

513 503 538

602 588 624 585 608 631

0

100

200

300

400

500

600

700

Number of Deaths

Incident Year

Suicides Occurring in Massachusetts, 2005-2015 

79
Source: MA Violent Death Reporting System, MA Department of Public Health

MA Data – Opioid Deaths

80
11%

18%

13%

17%

20%

27%

39%

43%

55%

0% 20% 40% 60%

Disclosed Suicide Intent

Physical Health Problem

Job/Financial Problem

History of Suicide Attempts

Intimate Partner Problem

Alcohol and/or Other Substance Problem

Current Treatment for Mental Health and/or

Substance Abuse Problem

History of Treatment for Mental Health Problem

Current Mental Health Problem

Figure 7A. Circumstances Associated with Suicide,

MA 2015 (N=631)7 

Source: MA Violent Death Reporting System, MA Department of Public Health

2015 Data – Circumstances Associated

with Suicides

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 Screening

 Life Skills

 Systems Changes

 Trainings 

Prevention Strategies

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 SBIRT

 Schools: The STEP Act (Massachusetts legislation, March 2016)

 Hospitals: Universal screening for suicidality and SBIRT

Prevention Strategies – Screening

83
Prevention Strategies – Life Skills

84
 Substance Treatment Centers becoming more co-occurring 

treatment focused

 Crisis Intervention Teams – Mental Health Clinician

 Zero Suicide

Prevention Strategies – Systems Changes

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Garrett Lee Smith Grant

 2 Partner hospitals

 Universal Screening – including SBIRT

National Strategies for Suicide Prevention

 Focus on a community approach (Cape Cod and the Islands)

 Learning Collaborative includes an addiction treatment facility

Zero Suicide

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 Training for substance use counselors on suicide prevention

 Crossover Trainings

 Annual Conference Workshop: Opioid and Suicide

 Opioid Public Health Crisis Grant – CDC

Prevention Strategies – Training

87
What have we learned?

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Resources

 MDPH Suicide Prevention Program –

mass.gov/dph/suicideprevention

 MDPH Opioid Quarterly Reports: 

https://www.mass.gov/lists/current-opioid-statistics

 MDPH Bureau of Substance Addiction Services (BSAS) –

mass.gov/dph/bsas

 Massachusetts Coalition for Suicide Prevention (MCSP) –

masspreventssuicide.org

 Zero Suicide – zerosuicide.org

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Contact

Kelley Cunningham

Director, Suicide Prevention Unit

Division of Violence and Injury Prevention

MA Department of Public Health

kelley.cunningham@state.ma.us

617-624-5460

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SAMHSA Resources

OPIOID MISUSE PREVENTION

• SAMHSA’s Center for the Application of Prevention Technology (CAPT)–Resources to Prevent the 

Non-Medical Use of Prescription Drugs, Opioid Misuse, and Opioid Overdose: 

https://www.samhsa.gov/capt/sites/default/files/resources/capt-resources-support-opioidmisuse-overdose-prevention.pdf

• Opioid Overdose Prevention Toolkit: https://store.samhsa.gov/product/Opioid-OverdosePrevention-Toolkit/SMA18-742

• Facing Addiction in America: The Surgeon General’s Spotlight on Opioids: 

https://addiction.surgeongeneral.gov/

SUICIDE PREVENTION

• In Brief: Substance Use and Suicide: A Nexus Requiring A Public Health Approach: 

https://store.samhsa.gov/shin/content//SMA16-4935/SMA16-4935.pdf

• SAMHSA’s Suicide Prevention Resource Center: http://www.sprc.org/

• National Suicide Prevention Lifeline: https://suicidepreventionlifeline.org/

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Related Media Awareness Campaigns

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• Crisis Next Door (White House): 

https://www.crisisnextdoor.gov/

• RxAwareness (CDC): https://www.cdc.gov/rxawareness/

• State Media Campaigns to Prevent Prescription Drug and 

Opioid Misuse: 

https://www.samhsa.gov/capt/sites/default/files/capt_res

ource/media-campaigns-prevent-rx-drugs-opioidmisuse.pdf
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