Cannabis Use Not Linked to Suicidal Thoughts Among Untreated Drug Users in Iran

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.

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.

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 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.

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.