Among 616 untreated illicit substance users, cannabis use was not independently associated with suicidal thoughts, while methamphetamine and heroin use were strongly linked to suicidality.
Suicide prevention professionals, addiction researchers, and mental health clinicians
Cannabis not associated with suicidal thoughts; methamphetamine and heroin were
What the researchers found
Regular cannabis use was not associated with increased odds of current suicidal thoughts in multiple logistic regression. In contrast, methamphetamine and heroin were independently associated with suicidal ideation. Methamphetamine was the primary substance of use among approximately half (49.2%) of those who attempted suicide in the past year.
Why it matters
Disentangling which substances contribute to suicidality is critical for targeted prevention. This study suggests that not all illicit substances carry the same suicide risk, with stimulants and opioids appearing far more concerning than cannabis.
The numbers in context
23.6% reported suicidal thoughts in the past week. 6.7% reported a suicide attempt in the past year. 49.2% of those who attempted suicide used methamphetamine as their primary substance. Cannabis use was not an independent predictor of suicidality.
How the study worked
Cross-sectional study of 616 illicit substance users recruited via snowball sampling from high-risk areas in Shiraz, Iran. Eligible participants used one illicit substance regularly for at least one year and had received no treatment in the past year. Suicidality was assessed using the Beck Suicidal Ideation Scale.
What this study cannot tell us
Cross-sectional design in a specific cultural context (Iran) limits generalizability. Snowball sampling may not represent all untreated users. The study assessed primary substance of use, but polysubstance patterns could confound results. Self-reported suicidality may be underestimated.
How to read the evidence
Reasonable sample size with validated suicidality measure, but cross-sectional design and convenience sampling from a single city limit conclusions.
When this study was published
2024 study
The bigger picture
The substance-specific differences in suicide risk have implications for how resources are allocated. If methamphetamine and heroin carry substantially higher suicide risk than cannabis, crisis intervention may need to be prioritized differently across substance-using populations.
Questions still open
- Would these patterns hold in Western populations with different substance use profiles? Does the route of cannabis administration matter for mental health outcomes? Could cannabis use actually be protective in some contexts, or is it simply neutral?
Common questions
Is cannabis use linked to suicide risk?
Which drugs are most associated with suicidal behavior?
Read the original research
Suicidal thoughts and behaviors among untreated illicit substance users: a population-based study.
Harm reduction journal, 21(1), 96
Citation
Shiraly, Ramin; Jazayeri, Seyed Amin; Seifaei, Asal; Jeihooni, Ali Khani; Griffiths, Mark D. (2024). Suicidal thoughts and behaviors among untreated illicit substance users: a population-based study.. Harm reduction journal, 21(1), 96. https://doi.org/10.1186/s12954-024-01015-9
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