AUDIE CORNISH, HOST:
The state of Massachusetts no longer refers to all opioid overdose deaths as accidents, and that's because some may be suicides. From member station WBUR in Boston, Martha Bebinger reports.
MARTHA BEBINGER, BYLINE: Mady Ohlman is 22 on the evening when she stands in a friend's bathroom looking down at the sink.
MADY OHLMAN: I had set up a bunch of different needles filled with heroin because I wanted to just do them back to back to back.
BEBINGER: Ohlman doesn't remember how many she injects before collapsing or how long she lays drugged out on the floor.
OHLMAN: But I remember being pissed because I could still get up, you know? I wanted to be out.
BEBINGER: Out as in dead.
OHLMAN: Yeah, like out.
BEBINGER: At this point, Ohlman has been addicted to opioids, controlled by the drug she says, for more than three years.
OHLMAN: And doing all these things you don't want to do that are horrible - you know, selling my body, stealing from my mom, sleeping in my car. How could I not be suicidal?
BEBINGER: For Ohlman, whose weight has dropped to almost 90 pounds, who was shooting heroin just to avoid feeling violently ill, suicide feels like a way out.
OHLMAN: You realize getting clean would mean a lot of work, and you realize dying would be a lot less painful. You also feel like you'll be doing everyone else a favor if you die.
BEBINGER: Ohlman, who has been sober for more than four years now, says many drug users hit this point when the disease and the pursuit of illegal drugs crushes their will to live. Ohlman, like about 40 percent of active drug users, wrestles with depression, anxiety or another mental health issue that increases her risk of suicide. Studies connecting drug addiction and suicide are sparse, in the words of Dr. Maria Oquendo, but consistent.
MARIA OQUENDO: Based on the literature that's available, it looks like it's anywhere between 25 and 45 percent of deaths by overdose that may be actual suicides.
BEBINGER: Oquendo, with the American Psychiatric Association, says the opioid epidemic is occurring at the same time suicides have hit a 30-year high, but few doctors look for a connection.
OQUENDO: They're not monitoring it. They're probably not assessing it in the kind of depth that they would need to and prevent some of the deaths.
BEBINGER: But some economists are making the connection and finding addictions and suicides fueled by fewer marriages, the loss of stable middle-class jobs and rising rates of self-reported pain. Princeton economics professor Angus Deaton co-authored a seminal paper last year on so-called deaths of despair.
ANGUS DEATON: We think of opioids as something that's thrown petrol on the flames and made things infinitely worse. But the underlying deep malaise would be there even without the opioids.
BEBINGER: There's growing agreement on remedies for that deep malaise - a good education, a steady job that pays a decent wage, secure housing, food and health care within a stable community. Michael Botticelli was drug czar under President Obama, is now at Boston Medical Center and is in recovery himself.
MICHAEL BOTTICELLI: Recovery is in essence restoring a sense of purpose and meaning in people's lives, giving them opportunities to establish positive, healthy relationships that can really diminish some of the isolation and despair.
BEBINGER: Mady Ohlman is rebuilding her life with 12-step meetings and a community of people who understand the addiction she still fights daily. Ohlman says she was lucky to get another chance.
OHLMAN: But a lot of people don't. They use opiates, and they know it's a hit or miss, and they're dying.
BEBINGER: And when they die, leaving a question that lingers - was it an accident or suicide? For NPR News, I'm Martha Bebinger in Boston.
CORNISH: This story is part of a reporting partnership with NPR, WBUR and Kaiser Health News.
(SOUNDBITE OF BILL FRISELL'S "BYE BYE BLACKBIRD")
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