National suicide and unintentional poisoning mortality rates have risen dramatically since 2000,1,2 by almost 20% and 140%, respectively. Both rate rises peak among the middle-aged population, not a historically high-risk injury group. Poisoning mortality is increasingly being driven by intoxication from pharmaceuticals, especially opioid analgesics.3 Collectively, these facts present vital challenges for clinical medicine, medicolegal death investigations, public safety, and public health. Concern about substance abuse sensitized us to a dormant issue of nonsuicide self-injury mortality and provokes our proposition that accounting of self-injury mortality must encompass more than suicide and its problematic measurement.
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