Which Drugs Belong on the Suicide List?

By Sally Chew 05/06/15

Street drugs can contribute to suicide, while psychedelics can help prevent it.

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With magic mushrooms and ayahuasca tea poised to take over mental health care anytime now (look out, Xanax and Prozac), users of other recreational drugs might keep in mind that most can make you depressed or even suicidal. 

New research says people who drink a lot of alcohol or take speedy drugs or opiates tend to hit the existential skids even more than previously thought, though this doesn’t necessarily happen by simple cause-and-effect.

Didier Jutras-Aswad at the University of Montreal concluded after a major study last year that, “Users of stimulants [amphetamines] and cocaine appear at particularly high risk of suicide attempt.” He doesn’t blame the drugs themselves as much as the “neurobiological, behavioral and social differences” between people who take them.

For instance, people who take uppers tend to be more impulsive and moody than the rest of us, according to Jutras-Aswad. They are quicker to move from feeling miserable on the couch to actually walking to the bathroom cabinet, opening a bottle of pills and swallowing a deadly dose. 

In one study, 43.5% of cocaine addicts said they’d tried to kill themselves. That doesn’t even include the John Belushis' and Whitney Houstons' of the world who, while pretty much headed toward death considering all the cocaine (and other drugs) they ingest, aren’t “trying” when they go.

As for amphetamines, some of the most traumatic stories come from prescription varieties such as Adderall: “The only way that I can work is if I take Adderall,” a woman named Eris recently posted online. “When I first take it, (after about 20 minutes) I can feel my body start to wake up, to get all heightened. My heart speeds up and I'm just toally RIPPED and PUMPED to do ANYTHING and EVERYHING. I've cleaned my room, run miles, written papers, gone to parties all psyched up everything. It lasts about three hours before I start to feel really tired and out of it...then, I get really sad and hollow. And finally, I get so depressed that I'm suicidal. If I can sleep it off, I'm OK...otherwise I just end up curling into a ball for a few hours wishing to die. Scary stuff.”

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Alcohol is the other big suicide marker. What a combo: Booze is a downer (it tends to make depressed people more depressed) and yet it overcomes inhibitions, too. People who drink heavily have five times the suicide risk of social drinkers. Forty percent of full-on alcoholics say they’ve tried to kill themselves at least once.

What’s new are tools for better prediction—on the way to better prevention. It turns out you can assess a drinker’s suicide risk not just by how much they drink and whether they’re depressed, or have alcoholics in the family, but whether they are a man or woman; how old they are; and whether they live in a “dry” culture where bingeing is the norm (higher rates) or a “wet” Southern European-style culture where alcohol is consumed in smaller, more frequent portions.

Also: How do they sleep? One alcohol-and-suicide study found insomnia was a “mediating” factor. Principal investigator Michael Nadorff at Mississippi State University, Starkville, said, “These results are important as they help demonstrate that alcohol use is associated with an increase in suicide risk, and that this increase may be partially due to insomnia symptoms.” 

Nadorff told me that “improving sleep in those who use alcohol may reduce the risk of suicidal behavior”—a refreshingly practical strategy that other studies are advocating, too. 

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Members of the Brazil-based Santo Daime church have a more time-tested solution for lifting spirits than simply getting better rest. During religious ceremonies they’ve been conducting since the 1930s (and indigenous people in the Amazon did it way before that), they sip a murky brown “wine” (called Daime as well) that’s made from psychoactive plants. 

Parishioners “trip” together for several hours at a time, sometimes as often as once a week, amid occasional vomiting (“purging”) and singing. When taken under the advisement of specific doctrinal teachings, the brew is said to bring spiritual enlightenment and meanwhile help with depression and addiction. 

“It is very common in our church to have cases of depression and yes, those are healed in our spiritual works. Hundreds of those cases,” said Fabio Pedalino, a Santo Daime church leader in the New York area.

He explained how Daime works on “emotional” depression (as opposed to the more persistent “chemical” depression, which the wine is said to cure as well):

“When the heart is aching, it sends ‘depression’ signals to the brain. In that case, the emotional has to be healed through comprehension and chemically the brain recovers normal chemical functions. Daime helps because it reestablishes comprehension of the facts quicker.”

Daime is fermented from ayahuasca, a consciousness-altering substance that is one of several intoxicants—including LSD, mescaline and psilocybin (aka magic mushrooms)—now in the spotlight as possible treatments for mental troubles including suicidality, aka suicidal thinking. 

Peter S. Hendricks  at the University of Alabama has discovered that people who have taken any of these so-called classic psychedelics (even just once) tend to attempt suicide less often than other people, and they think about it (i.e., experience suicidality) much less, too. 

His work is part of a new, second wave of psychedelic treatment research; the first was shut down in the early '70s when the U.S. government first declared its War on Drugs and designated LSD, psilocybin and the rest, as dangerous. Apparently, tens of thousands of people had been treated successfully in the '50s and '60s.

Hendricks believes these drugs’ anti-suicide benefits suggest great potential for treating other human suffering as well: “When you can mobilize that energy that speaks to what our ultimate life purpose is, then you’re going to have a wide range of effects not only on mood but on cognition, not only on mood disturbances but also on addictive behavior and perhaps even how people process traumatic memories.”

He pictures a future where you will check into a facility for a matter of hours and allow health care workers to guide you through the experience: “I think we’ll have, for lack of a better term, psychedelic treatment centers. I’m talking about treatment centers where psychedelic substances are administered in a therapeutic context. I think we could see such centers begin to emerge within 10 years.” Perhaps, one visit would do it for some people. 

I asked Dr. Hendricks to connect his suicide work on psilocybin to research now underway involving treatment for terminally ill patients’ various anxieties, especially their fear of death. 

He said, “People have asked, ‘So if you reach the point where you have no fear of dying whatsoever, might that make you more likely to commit suicide?’ And I would say, ‘No.’ I think a healthy view of death is probably indicative of a healthy view of life.”

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There is still some disagreement about which drugs belong on the suicide list. Some scientists consider opiates (such as heroin) to put users at risk; others not so much. In the realm of prescription drugs, most include sedative-hypnotic medications (barbiturates and benzodiazepines) and certain antidepressants. 

It’s on the psychedelic “prevention” side that it’s most clear which drugs are in and which are out. For instance, MDMA, the active ingredient in ecstasy, is less popular in the lab, because while it has similarities to classic psychedelics, in other ways it’s more like amphetamines. Dr. Hendricks in Alabama isn’t interested because of evidence that it can cause long-term serotonin damage. 

A lot may change in this field by the time your town has a psychedelic treatment center of its own, inviting traditional street drugs into a controlled environment and offering one-on-one guidance through a relatively safe personal trip. Certainly the research will be more advanced so the whole scenario will be less shocking. 

Of course, changing a drug's status from illegal to legal can stoke as many fears as it calms. Take marijuana’s legalization in some states, along with a whole industry of pot snacks and hospitality services. There has never been much evidence about the drug either encouraging or discouraging suicide, but last month a 23-year-old shot himself in Colorado after eating lots of pot-laced candy, and his parents claim he was fine until he ate it.

People love to blame their problems on drugs, but usually there is also something else going on. Suicide researchers quote Sidney Cohen, who did a large-scale survey about psychedelic use in the '60s and wrote, "It is noteworthy that all the suicidal acts have been in disturbed patients rather than normal subjects." 

Sally Chew was an editor at Time Inc.’s Health.com as well as at Vibe, Out and POZ magazines. She also authored a true crime book and was a wire-service reporter overseas. She last wrote about oxytocin.

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Sally Chew was an editor at Time Inc.’s Health.com as well as at Vibe, Out and POZ magazines. She also authored a true crime book and was a wire-service reporter overseas. She last wrote about marijuana, the way our ancestors smoked it and which drugs belong on the suicide list. You can find Sally on Linkedin and Twitter.

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