BACKGROUND:
Suicide is a significant global public health issue, especially among key populations such as individuals with substance use disorders (SUDs), particularly those with opioid use disorders (OUDs). Previous research has linked unintentional overdose (OD) with suicidality, suggesting that people with OUDs may experience a diminished desire to live due to addiction. Despite this, few studies have examined suicidality among at risk PWID, particularly among those residing in rural U.S. counties.

METHODS:
We utilized cross-sectional pilot data from 80 PWID to examine the prevalence and correlates of suicidality among adults who inject drugs in rural Appalachia.

RESULTS:
In our sample of PWID, the majority were female (52.5%), approximately 40 years (M=39.7; SD=9.2), with most reporting experiences of overdose in their lifetime (80.0%). Approximately 24% of the participants reported experiencing suicidal ideation at some point in their lives. Additionally, about 43.0% indicated that they had been unstably housed in the previous 90 days, with a significant portion (75.0%) reporting symptoms of severe mental health disorders (MHD) in the past year. We found significant differences between PWID groups that reported suicidality vs. those that did not, specifically in their past 90 days experiences of unstable housing [Chi-square = 4.351 [df=1], p=0.037], past year experiences of MHD symptomology [Chi-square = 5.177[df=1], p=0.023], and overall resilience scores [Chi-square = 7.735[df=1], p=0.005].

CONCLUSIONS:
Our findings emphasize the need for regular screening for suicidality among people who inject drugs (PWID). Additionally, it is crucial to improve access to integrated services that address not only mental health issues but also the social determinants of health, such as unstable housing. Furthermore, the results underscore the significance of considering social capital factors, like resilience, when designing tailored interventions for socially vulnerable PWID.