Overdose deaths in the UK continue to climb each year, highlighting a persistent and escalating public health crisis. In 2022 alone, there were 4,907 drug poisoning deaths recorded, the highest since records began, with a substantial portion linked to mental health challenges that often go unnoticed or untreated. 

This troubling rise underscores not only the prevalence of substance misuse but also the complex relationship between mental health issues and the risk of overdose. To understand one issue, we need to understand the other. By understanding the mental health underpinnings of overdose, we can better tailor prevention and intervention efforts to those most at risk.

Understanding Overdose: Definitions and Types

An overdose occurs when someone consumes an excessive amount of a substance, leading to serious medical complications or fatal outcomes. This excessive intake can surpass the body’s capacity to detoxify and process the substance, often resulting in critical health consequences. Overdoses can be classified into two main types: unintentional and intentional.

• Unintentional overdoses occur without the intent to harm oneself. They often involve prescription medications, where individuals may take more than the prescribed dose, combine medications with other drugs or alcohol, or use a prescription that was not intended for them. Common substances involved in unintentional overdoses include opioids, benzodiazepines, and antidepressants, which can suppress vital bodily functions at high doses. The rise of opioids as a major public health issue is particularly concerning due to their potency and potential for addiction.
• Intentional overdoses are acts where individuals consume a substance to inflict harm upon themselves. This type often intersects with mental health crises, where substances are used as a means to cope with overwhelming distress or to attempt suicide. Intentional overdoses require urgent mental health interventions alongside medical treatment to address the underlying emotional and psychological distress.

Opioids are the most frequent culprits in both unintentional and intentional overdose scenarios due to their ability to depress the respiratory system. When opioids are taken in large quantities, they can halt breathing, leading to hypoxia (lack of oxygen reaching the brain), which can quickly become fatal without immediate medical intervention.

Mental Health and Overdose Risk 

The intricate relationship between mental health disorders and the risk of overdose is substantiated by vast statistical evidence, demonstrating that mental health disorders significantly elevate the risk of both unintentional and intentional overdoses. In a review of 38 studies, it was highlighted that 37 found a clear link between mental health conditions and the increased likelihood of substance overdoses.[1]

Research across different demographics indicates that a substantial proportion of individuals who experience overdoses suffer from concurrent mental health disorders. For example, studies across the United States have shown that people with mood disorders are significantly more likely to suffer from opioid-related overdoses. Another study in Ontario, Canada, found that people with mood disorders were significantly more likely to experience overdoses compared to those without. The adjusted odds ratio (AOR) was 1.80, indicating that they had an 80% higher chance of having an opioid overdose than those without depression.[2]

Anxiety disorders also show a significant association with overdose risks. In British Columbia, for example, 30.0% of men and 45.0% of women with anxiety disorders experienced opioid overdoses, markedly higher than their counterparts without such disorders.[3]

Studies involving people with PTSD, particularly those undergoing treatment for substance use disorders, also indicate a higher propensity for overdoses. For instance, in Boston, the odds of non-fatal opioid overdose were significantly higher among those with PTSD, with an AOR of 2.77.[4] Other studies have found a link between overdose and personality disorders, antisocial behaviour (AOR 2.20), and ADHD, where 12% of people who had overdosed had ADHD compared to 4.6% of those without it.[5][6]

The data clearly illustrate that mental health disorders significantly increase the risk of overdose, highlighting the need for integrated approaches in healthcare that address both mental health and substance use issues comprehensively.

The Role of Prescription Medications

Prescription medications, particularly opioids, occupy a complex position in the intersection between mental health issues and overdose risks. These medications serve as both necessary treatments for various conditions and potential triggers for overdose, especially among those with existing mental health disorders.

Prescription opioids are commonly prescribed for pain management but carry a high risk of addiction and overdose. The dual role of these medications as both a treatment and a risk factor requires careful management, particularly for individuals with mental health conditions.

Data indicates that the risk of overdose increases significantly when opioids are prescribed to individuals with mental health disorders. This risk is compounded by factors such as dosage, duration of prescription, and the specific mental health issues present.[7] It has also been found that people are particularly vulnerable to overdose if they are tapering off medication; this has the dual threat of old symptoms re-emerging combined with a lowered substance tolerance.[8]

Addressing the Challenge: Prevention and Intervention Strategies

The rising incidence of overdoses, particularly those linked to mental health issues, calls for comprehensive prevention and intervention strategies. These approaches must not only address the immediate risks but also the underlying mental health conditions that contribute to overdose vulnerability.

Preventive Measures:

• Monitoring and Support: Healthcare providers must be vigilant in monitoring patients who are prescribed opioids or other high-risk medications, especially those with known mental health disorders. Regular follow-ups and assessments can help identify potential misuse or escalating risks early.
• Education and Awareness: It is vital to educate patients about the risks associated with their prescriptions and the importance of adhering to prescribed doses. This education should also cover the dangers of combining medications with alcohol or illicit drugs.[9]

Integrated Care Approaches:

• Coordinated Treatment Plans: Effective management of patients with mental health disorders and risk of overdose often requires a coordinated approach that integrates mental health and substance misuse treatments. This might include combining pharmacotherapy with psychotherapy or counselling services.
• Tailored Therapeutic Strategies: Treatment plans should be individualised, taking into account the patient’s mental health status, substance use history, and other personal factors. Such personalised care can significantly enhance the effectiveness of interventions and reduce the risk of overdose.

Community and Policy-Level Interventions:

• Access to Mental Health Services: Enhancing access to comprehensive mental health services can prevent the escalation of conditions that may lead to an overdose. Community programmes that provide easy access to mental health care and substance misuse treatment can play a vital role.
• Legislative Actions: Policies that regulate prescription practices and promote safe prescribing can reduce the availability of excess medications that could potentially be misused.

Take Action for Mental Health and Overdose Prevention

As we navigate the complexities of mental health and its impact on overdose risks, each of us needs to stay vigilant and proactive. At The Revoke Programme, we’re committed to providing comprehensive support and effective solutions for those dealing with mental health challenges and the threat of overdose. 

If you or someone you know might be at risk, don’t hesitate to seek help. Contact Revoke today to learn how we can assist you or your loved ones in managing mental health or substance use disorder effectively.

Sources:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601097/
2. https://pubmed.ncbi.nlm.nih.gov/26014916/
3. https://pubmed.ncbi.nlm.nih.gov/30439611/
4. https://pubmed.ncbi.nlm.nih.gov/31692644/
5. https://pubmed.ncbi.nlm.nih.gov/15462639/
6. https://pubmed.ncbi.nlm.nih.gov/31730188/
7. https://www.nejm.org/doi/full/10.1056/NEJMra1802148
8. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793293
9. https://psychiatryonline.org/doi/10.1176/appi.ajp.2011.10101476