BACKGROUND Opiate misuse has reached epidemic levels. Prevention efforts depend on distinguishing opiate users from abusers. The current study compared opioid users who died by natural cases, accidents, and suicide using psychological autopsy methods. Groups were compared on substance use characteristics, treatment history, experiences of negative life events, and circumstances at the time of death. METHODS Substance use and suicide risk were evaluated using psychological autopsy methods in 63 decedents with positive toxicology for opiates at death divided into three groups: adults dying by suicide (n = 19), accident (n = 19), and natural causes (n = 25). Groups were compared on several dependent measures, using chi-square analyses to examine categorical variables and one-way analyses of variance (ANOVA) to examine continuous variables. RESULTS Individuals who died by suicide were similar in many ways to adults who died by an accidental overdose. However, suicide completers were more likely to have struggled with severe depression, and previously attempted suicide, whereas the accidental overdose sample was more likely to display a chronic pattern of severe drug abuse. CONCLUSIONS The current study helps to distinguish between opiate users who are at risk for death by an accidental or intentional overdose. In the ongoing opiate crisis, clinicians must understand the risk of overdose and the nuances of accidental behaviors compared to purposeful ones. Signs of suicidal planning, relevant psychopathology, and ongoing life stress may be useful points of intervention for stopping the increasing number of deaths among opiate users.

中文翻译：

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急性应激源和临床特征区分了非法和处方鸦片使用者的自杀，事故或自然原因所致的死亡。

背景技术阿片滥用已达到流行水平。预防工作取决于将鸦片使用者与滥用者区分开。当前的研究使用心理尸检方法比较了因自然病例，事故和自杀死亡的阿片类药物使用者。比较各组的物质使用特征，治疗史，不良生活事件的经历以及死亡时的情况。方法采用心理尸检方法对63名死于鸦片制剂的毒理学呈阳性的死者进行物质使用和自杀风险评估，将其分为三组：成年人自杀死亡（n = 19），意外死亡（n = 19）和自然原因（n = 25）。使用卡方分析检查类别变量，使用单向方差分析（ANOVA）检查连续变量，以几种因果措施对组进行比较。结果自杀死亡的个人在很多方面与因意外过量死亡的成年人相似。但是，自杀完成者更可能与严重的抑郁症作斗争，并且以前曾尝试自杀，而意外的过量用药样本更可能表现出严重的药物滥用的慢性模式。结论当前的研究有助于区分因意外或故意过量服用而有死亡危险的阿片使用者。在持续的鸦片危机中，与有目的的相比，临床医生必须了解服用过量的风险和意外行为的细微差别。自杀计划的迹象，相关的精神病理学和持续的生活压力可能是干预措施，可用来制止鸦片使用者死亡人数的增加。