Utah leaders have done a bold thing this year to protect the state’s residents: suing certain pharmaceutical companies for what has been characterized in different lawsuits as “callous” and “aggressive” marketing to promote opioids while concealing significant risks. As a result of these tactics, far too many have died of opioid overdose.
While applauding historic actions of state leadership, we can’t help but wonder whether we have assumed too quickly that these industry tactics are somehow exclusive to opioids.
As local citizens who have spent years in mental health education, we write to highlight overlooked similarities between industry influences on our opioid and suicide crises.
A Weber County lawsuit alleged that having “trivialized or obscured [opioids’] serious risks,” companies convinced doctors and patients “that the compassionate treatment of pain required opioids.” And a Utah County Commission resolution stated that despite “knowing of the serious risks and adverse outcomes related to the use of their opioids,” companies “nevertheless set out in the 1990s and 2000s to persuade providers, regulators and patients that opioids are safe and effective.”
This same minimization of risks has been plainly documented in industry marketing for antidepressants — a campaign so successful that most people consider them first-line, and increasingly long-term solutions. Indeed, a majority of legislative and educational efforts to reduce suicide (including Sen. Orrin Hatch’s new proposal) aim to essentially increase “treatment access” — which (despite the range of options available) most often means psychiatric treatment.
Will that reduce the heartbreaking numbers?
How we all wish it would! But we have to ask: haven’t we tried this already? Between the early 1990s and 2008, antidepressant use in teens and adults quadrupled — with rates climbing even further in the past 10 years. In this same period, numbers of suicide and chronic disability for mental illness reached record levels — with 600,000 youth and 4 million adults on disability for mental illness today (compared with 16,200 and 1.25 million in 1987).
Despite these troubling statistics, “under treatment” and “treatment stigma” continue to be held up as primary barriers to reducing suicides — almost without question.
Could it be time to reconsider our basic approach? We believe the evidence compels a broader conversation about suicide prevention and mental health overall.
These are not outlier concerns. Recall that the FDA mandated a warning on antidepressant packaging because of the evidence for heightened suicidality with teenage brains. And 20 peer-reviewed adult studies have found consistently poor outcomes with long-term antidepressant use.
Please don’t misunderstand. We are not recommending that anyone stop current medical treatment, which only a doctor can advise. Nor are we saying any treatment option be made less available.
What we’re encouraging is more conversation about sensible adjustments to standard protocols, including: (1) informed consent that better acknowledges risks without overstating benefits, (2) more careful monitoring of heightened suicidality risk during any dosage change, (3) increased support for careful, gradual, and supervised discontinuation when medication benefits have ceased, and especially (4) greater priority attention to hundreds of other ways to boost mood and relieve emotional distress.
There are so many reasons to be hopeful! In our own classes, we’ve seen hundreds of people find more sustainable healing when they begin to decrease core risk factors for emotional distress, one at a time.
Our ultimate plea is for state leaders to ensure that conversations about suicide prevention don’t naively adopt talking points touted by industry-funded researchers or organizations (our tragic opioid mistake), while allowing all perspectives to be included — even those that may be challenging to hear.
The preciousness of each individual life calls for no less.
Jacob Hess, Ph.D., Jocelyn Pedersen, Cassandra Casey, Holli Oram, Karen Welch and Ed and Sharon Fila are involved in local mental health education in partnership with the Utah nonprofit All of Life.