Association between binge drug use and suicide attempt among people who inject drugs

ABSTRACT

Background: People who inject drugs (PWID) have an elevated risk of suicide attempt. Although different substances are associated with suicide attempt, the overall risk posed by binge behavior, a high-risk pattern of drug use, remains unclear. The objective of this study is to assess the association between binge drug use and suicide attempt in a prospective cohort of PWID in Montreal, Canada. Methods: Participants answered a biannual interviewer-administered questionnaire compiling information on sociodemographics, pattern of substance use (cocaine, amphetamine, opioids, sedative-hypnotics, alcohol, and cannabis), and psychosocial stressors and related markers. The relationship between suicide attempt and binge behavior was modeled using generalized estimating equations (GEEs), controlling for type and pattern of substance use, sociodemographic characteristics, and significant mental health markers. Results: Among 1240 participants (mean age ± SD: 38.2 ± 9.8) at baseline, 222 (17.9%) reported binge during the past 6–months. PWID reporting binge were significantly younger (P < .001), less educated (P = .012), less likely male (P = .047), and had shorter history of injection (P < .001). In addition, they were younger at first injection (P = .014), reported higher rates of prostitution and psychological disorders (P = .003), and were more likely to use other drugs except cannabis and alcohol. Binge was independently associated with attempted suicide in the GEE multivariate model (adjusted odds ratio [aOR 95% CI] = 1.91 [1.38–2.65], P < .001). Conclusions: Among PWID at high risk of suicide attempt, those who binge represent a particularly vulnerable subgroup. Although the exact mechanisms underlying this finding remain unresolved, several hypothesis pertaining to the neurobiological and psychosocial consequences of binge, as well as common personality traits, warrant further investigations.

KEYWORDS:

• Cocaine
• binge
• injection drug use
• mental health
• opioid
• suicide

Acknowledgments

The authors would like to thank Rachel Bouchard, the HEPCO research staff, as well as all study participants without whom this work would not have been possible.

The authors declare that they have no conflicts of interest.

Funding

The HEPCO study is funded through a Canadian Institute on Health Research grant (MOP135260; MOP210232) and additional support from the Réseau SIDA et Maladies Infectieuses du Fonds de la Recherche en Santé du Québec (FRSQ5227). This work was supported by the Quebec Network on Suicide, Mood Disorders and Related Disorders (FRQS-RQSHA). A.A.A. was supported by an MSc salary award through the National CIHR Research Training Program in Hepatitis C. D.J.A. holds a clinical researcher career award from the Fonds de Recherche du Québec—Santé (FRQS). Funding bodies did not have a role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Author contributions

C.F. participated in the study design, conducted the analyses, and drafted the manuscript. M.F.G. reviewed data analysis and contributed to drafting and revision of the article. A.A.A. contributed to the study design, interpretation of findings, and revision of the manuscript. G.Z. made substantial contributions to the analysis of data and revision of manuscript. E.R. contributed by designing and directing the HEPCO cohort, its global analysis, and reviewing the article. J.B. and D.J.A. contributed to the study design, data analysis, interpretation of findings, and writing of the manuscript. D.J.A. oversaw the project, and J.B. directed the research study from which the data were derived. All authors approved the final version of the manuscript.