# Suicidal intent in fatal drug overdoses

> **NIH NIH R21** · NORTHWESTERN UNIVERSITY · 2024 · $240,000

## Abstract

Project Summary
The national suicide rate has grown by 30% over the last twenty years, and nearly 46,000 people died by
suicide in 2020. The rate of drug overdose death has grown even more dramatically over the same period.
Nearly 108,000 people died by drug overdose in 2021, an all-time high. Substance use and suicidal ideation
are strongly correlated. This overlap makes intent difficult for death investigators to classify in fatal drug
overdoses. Consequently, many overdose deaths ruled unintentional or “undetermined” may in fact be suicide
victims. This project will leverage data from death certificate, toxicology, police, and coroner/medical examiner
reports to investigate how medicolegal death investigators classify intent within fatal drug overdoses. The data
sample contains three states in a region with high rates of drug abuse and overdose death. With a mixed
methods approach of quantitative and linguistic analysis, the project will first identify which factors are most
predictive of intent classification. Potential factors include characteristics of decedents, death investigation
systems, and the socioeconomic conditions of communities. The principal data sources are the National
Violent Death Reporting System (NVDRS) and the State Unintentional Drug Overdose Reporting System
(SUDORS). Both sources contain decedent-level information. Whereas NVDRS contains intentional deaths by
drug poisoning (suicide), SUDORS contains unintentional (accidental) and “undetermined” deaths. The
combination of these sources will provide novel insight on suicidal intent among fatal drug overdoses. The
project will also develop a statistical adjustment to estimate underreported suicide deaths. This adjustment will
build from a model of suicide deaths by drug poisoning (in NVDRS) to estimate rates of underreported suicide
deaths in the unintentional and “undetermined” fatal overdose deaths (in SUDORS). The project will therefore
help identify populations in critical need of mental healthcare access and treatment. Furthermore, unintentional
drug overdose deaths and suicide deaths require a different set of prevention strategies and policies. Accurate
mortality surveillance systems are therefore central to either prevention effort. The analyses in this project will
inform points of intervention for death investigator instruction on the important classification of intent within fatal
drug overdoses.

## Key facts

- **NIH application ID:** 10880425
- **Project number:** 5R21DA059189-02
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Alexander Lundberg
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $240,000
- **Award type:** 5
- **Project period:** 2023-07-01 → 2025-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10880425

## Citation

> US National Institutes of Health, RePORTER application 10880425, Suicidal intent in fatal drug overdoses (5R21DA059189-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10880425. Licensed CC0.

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