Cocaine-involved suspected suicide attempts in individuals age 50 and older reported to United States Poison Centers

Abstract

Context

Despite a rapidly growing number of older cocaine users, the link between cocaine use and suicide attempt in older adults has not been examined. We examined associations between co-used other substances and (1) suspected suicide attempts versus other intentional misuse, and (2) major medical outcomes (major effect or death) of suspected suicide attempts and other intentional misuse.

Methods

We used the 2015–2021 United States National Poison Data System (N = 5,191 cases age 50 and older). Descriptive statistics and generalized linear models for a Poisson distribution with a log link function were used to examine the study questions.

Results

Cocaine exposures steadily increased from 2015 through 2021. Over the seven years, 52.3% and 47.7% were suicide attempts and other intentional misuse cases, respectively. Co-use of alcohol (incidence rate ratios = 1.24, 95% confidence interval = 1.14–1.35) and psychotropic (e.g., antidepressants: incidence rate ratios = 1.37, 95% confidence interval = 1.24–1.53) and cardiovascular medications were associated with a higher likelihood of suicide attempt, but co-use of prescription opioids, heroin, or other illicit drugs was associated with a lower likelihood of suicide attempt compared to other intentional misuse. Prescription opioids and amfetamine were associated with a higher likelihood of major effect or death in both suicide attempts and intentional misuse and heroin use and injection use were associated with a higher likelihood of major effect/death among intentional misuse cases.

Conclusions

These findings show that significant proportions of older cocaine users who attempted suicide also used psychotropic and cardiovascular medications. We suggest that healthcare providers screen for suicidal ideation among cocaine users, with special attention to an increased risk of suicide attempts among those who co-use cocaine with alcohol and psychotropic and other prescription medications.

Keywords:

• Older adults
• suicide attempt
• cocaine
• prescription and illicit opioids
• psychotropic medications

Acknowledgements

The American Association of Poison Control Centers made the National Poison Data System (NPDS) available to the authors for this study. This study’s findings and conclusions are those of the authors alone and do not necessarily represent the official position of the American Association of Poison Control Centers or participating poison control centres.

Author contributions

All authors contributed to conceptualization. SDB applied for and obtained the de-identified NPDS data and provided overall guidance on the data system and analysis. NGC conducted data analysis and drafted the paper. BYC provided consultation on pharmaceutical and medical content. CNM provided statistical consultation. All authors contributed to the final editing and agree to the publication of the paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Disclaimer statement

America’s Poison Centers maintains the National Poison Data System (NPDS), which houses de-identified records of self-reported information from callers to the country’s poison centres. National Poison Data System data do not reflect the entire universe of exposures to a particular substance as additional exposures may go unreported to poison centres; accordingly, NPDS data should not be construed to represent the complete incidence of US exposures to any substance(s). Exposures do not necessarily represent a poisoning or overdose and America’s Poison Centers is not able to completely verify the accuracy of every report. Findings based on NPDS data do not necessarily reflect the opinions of America’s Poison Centers.

Additional information

Funding

This work was supported by National Institute on Aging. This research was supported by grant, P30AG066614, awarded to the Center on Aging and Population Sciences at The University of Texas at Austin by the National Institute on Aging. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.