Understanding Links among Opioid Use, Overdose, and Suicide

To the Editor: Bohnert and Ilgen (Jan. 3 issue) 1 provide a thoughtful perspective on opioid-related suicides. They describe “Deaths of Despair,” 2 an epidemiologic concept that warrants further root-cause analysis, particularly in geographic areas that are disproportionately affected by the opioid crisis. The current boom–bust era of the coal industry has contributed to the uncertain welfare of the Appalachian population. 3 At the same time, since 2006, persons in working-class mining communities, in addition to those in communities in urban areas, have consumed alarming quantities of opioid medications. 4 This prompts the question of whether opioid use and subsequent addiction begin in a . . .