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Letters
Open Access

Determining intent behind poisoning suicides

Kayvan Aflaki and Joel Ray
CMAJ April 26, 2021 193 (17) E622; DOI: https://doi.org/10.1503/cmaj.78591
Kayvan Aflaki
MSc candidate, Institute of Medical Science, Toronto, Ont.
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Joel Ray
Physician, Departments of Medicine and Obstetrics and Gynaecology, St. Michael’s Hospital, Toronto, Ont.
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We thank Liu and colleagues for their article that described important temporal patterns about suicide in Canada.1 The decline observed in the age-standardized rate of suicide by poisoning leads us to wonder whether this may be because of misclassification of such suicides. This is important given concerns about rising suicidality among young and middle-aged adults, particularly during the current COVID-19 pandemic.2

Accidental poisonings now mainly include illicit drug overdoses among adults, and it is at the discretion of a medical examiner or coroner to determine whether or not that death was “accidental,” based on the circumstances and evidence surrounding the death.3 Deaths by firearm or suffocation (hanging) 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 because of 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-related deaths among those aged 15–24 years, with greater than half of all deaths among those aged 18–24 years occurring outside of hospital.5 Hence, it is quite conceivable that more poisonings in Canada are both intentional and suicidal than realized.

Future research should re-evaluate poisoning deaths of undetermined intent, to elucidate what proportion are actually missed suicides.

Footnotes

  • Competing interests: None declared.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

References

  1. ↵
    1. Liu L,
    2. Capaldi CA,
    3. Orpana HM,
    4. et al
    . Changes over time in means of suicide in Canada: an analysis of mortality data from 1981 to 2018. CMAJ 2021;193: E331–8.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Varin M,
    2. Orpana HM,
    3. Palladino E,
    4. et al
    . Trends in suicide mortality in Canada by sex and age group, 1981 to 2017: a population-based time series analysis. Can J Psychiatry 2021;66:170–8.
    OpenUrl
  3. ↵
    1. Miech R,
    2. Koester S,
    3. Dorsey-Holliman B
    . Increasing US mortality due to accidental poisoning: the role of the baby boom cohort. Addiction 2011;106:806–15.
    OpenUrlCrossRefPubMed
  4. ↵
    Canadian Institute for Health Information (CIHI); Canadian Centre on Substance Abuse. Hospitalizations and emergency department visits due to opioid poisoning in Canada. Ottawa: CIHI; 2016.
  5. ↵
    1. Ray JG,
    2. Guttmann A,
    3. Silveira J,
    4. et al
    . Mortality in a cohort of 3.1 million children, adolescents and young adults. J Epidemiol Community Health 2020;74:260–8.
    OpenUrlAbstract/FREE Full Text
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Canadian Medical Association Journal: 193 (17)
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Vol. 193, Issue 17
26 Apr 2021
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Determining intent behind poisoning suicides
Kayvan Aflaki, Joel Ray
CMAJ Apr 2021, 193 (17) E622; DOI: 10.1503/cmaj.78591

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Determining intent behind poisoning suicides
Kayvan Aflaki, Joel Ray
CMAJ Apr 2021, 193 (17) E622; DOI: 10.1503/cmaj.78591
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