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As many as 30% of overdose deaths ruled accidental/undetermined may be suicides, according to a new analysis.

People with alcohol, drug, and tobacco use disorders have about 11 times the odds of dying by suicide.

Clinicians should ask about suicidal intent after every nonfatal overdose and throughout addiction treatment.

Recovery Month and Suicide Prevention Awareness Month both fall in September. One focuses on people who struggle with addiction, and the other focuses on people we have lost to suicide and those still at risk. In most communities, they run on parallel tracks. The recovery rally and the suicide prevention walk rarely share a stage, and the people planning them don’t often sit in the same meetings.

I have worked with grief, trauma, and addiction for more than 35 years, and I’ve long suspected the two observances are talking about a lot of the same people. This summer, a group of researchers put some solid numbers behind that hunch.

What the Death Certificates Miss

In a commentary published online in July in Injury Prevention, injury epidemiologist Ian Rockett, psychiatrist Eric Caine, and their colleagues looked at U.S. deaths from 2000 through 2024. Over those years, the suicide rate rose 37.5 percent and drug poisoning deaths more than tripled. Yet the rate of drug poisoning deaths officially recorded as suicide went from only 1.3 to 1.8 per 100,000.

If overdose deaths tripled and suicides climbed by more than a third, you would expect overdose suicides to rise along with them. Rockett estimates that as many as 30 percent of overdose deaths labeled accidental or undetermined could be suicides. Part of the problem is how intent gets decided. A medical examiner or coroner has to make that call after the person has died, and when there is no note and no documented psychiatric history, the ruling usually lands on accident. Rockett put it plainly: “Most drug overdoses are the result of motivated behaviors and aren’t ‘accidents’ in the strict sense.”

To get a sense of scale, take the CDC’s latest provisional count of 67,798 overdose deaths for the 12 months ending in March 2026. The official suicide total for 2024 was 48,824. If one in ten of those overdoses was really a suicide, the national suicide count would be roughly 14 percent higher than what we........

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