So many drug overdoses are labeled as accidents rather than intentional suicides.
I imagine a high proportion of these deaths of despair were carried out by passively suicidal individuals who simply didn't care to see if they lived another day. A sort of Russian roulette, I suppose.
The number of actual suicides is definitely underreported. Where I come from, family members will feel extremely ashamed/embarrassed to know their relative caught the bus, so many of them will lie and claim it was an accidental overdose instead.