- Page navigation anchor for Determining intent behind intentional vs. non-intentional poisoning suicidesDetermining intent behind intentional vs. non-intentional poisoning suicides
We thank Liu and colleagues for their article published in CMAJ entitled, “Changes over time in means of suicide in Canada: an analysis of mortality data from 1981 to 2018”.1 Their study described important temporal patterns about suicide in Canada. Their reported decline in the age-standardized rate of suicide by poisoning leads us to wonder whether this may be due to misclassification of such suicides. This is important during the current era of the COVID-19 pandemic, and concern about the rise of suicidality among young and middle-aged adults.2
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“Accidental poisonings” now largely comprise illicit drug overdoses among adults, and it is at the discretion of a medical examiner or coroner to determine whether that death was “accidental,” based on the circumstances and evidence surrounding the death.3 Firearm or suffocation (hanging) deaths are much more likely to be deemed a suicide in the absence of any corroborating evidence (e.g., a suicide note) or an external perpetrator (i.e., evidence of a homicide). In contrast, a death by an overdose is particularly susceptible to being misclassified as an “accidental poisoning”, especially in the current era of opioid overuse.
Recent Canadian data have shown a resurgence in poisoning deaths due to the opioid epidemic. More than 50% of poisonings among Canadian youth presenting to hospital are intentional.4 Population-based data show that accidental poisonings and overdoses account for nearly half of all injury-re...Competing Interests: None declared.References
- 1. Liu L, Capaldi CA, Orpana HM, Kaplan MS, Tonmyr L. Changes over time in means of suicide in Canada: an analysis of mortality data from 1981 to 2018. CMAJ. 2021;193(10);E331-E338.
- 2. Varin M, Orpana HM, Palladino E, Pollock NJ, Baker MM. Trends in suicide mortality in Canada by Sex and Age Group, 1981 to 2017: a population-based time series analysis. Can J Psychiatry. 2021;66(2):170–78
- 3. Miech R, Koester S, Dorsey-Holliman B. Increasing us mortality due to accidental poisoning: the role of the baby boom cohort. Addiction. 2011;106:806–15.
- 4. Canadian Institute for Health Information, Canadian centre on substance abuse. Hospitalizations and emergency department visits due to opioid poisoning in Canada. Ottawa, ON: CIHI, 2016.
- 5. Ray JG, Guttmann A, Silveira J, Park AL. Mortality in a cohort of 3.1 million children, adolescents and young adults. J Epidemiol Community Health. 2019;0;1–9.
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