Is opioid use disorder (OUD) associated with increased risk for suicide?
Yes. Cohort studies find that having OUD is associated with 13 times greater risk for suicide, even controlling for co-occurring mental health disorders. Suicide is undercounted in deaths of opioid-related overdose, and the risk for suicide in OUD is probably underestimated.
What type of suicide screening is most appropriate for OUD patients?
This depends on your care setting. Health care providers who evaluate patients in acute care settings, with no prior care relationship and unlikely to become involved in a longer-term care relationship, can effectively use validated brief screenings tested for use in these settings. Examples include the ED Safe Patient Safety Screener (PSS-3) for emergency department care, or the Ask Suicide Screening Questions Toolkit (ASQ) for inpatient medical and surgical settings and primary care. Keep in mind that although item 9 on the Patient Health Questionnaire (PHQ-9) relates to suicide screening, the PHQ-9 was developed as a screen for major depressive episode and as such is less well-validated for suicide screening compared with other brief screens noted above. For behavioral health settings and longitudinal care, the Columbia-Suicide Severity Rating Scale (C-SSRS) is well-validated for monitoring enduring suicide risk. In all cases, clinical concern based on risk factors and/or positive screening results should be immediately followed by comprehensive mental health safety evaluation and safety planning, including means reduction, such as removing the person from unsafe access to opioid analgesics, drugs and alcohol and educating family on the use of naloxone rescue for opioid-related overdose. Further materials may be found at the Suicide Prevention Resource Center (sprc.org) and in the downloadable pdf, National Action Alliance for Suicide Prevention: Transforming Health Systems Initiative Work Group. (2018). Recommended standard care for people with suicide risk: Making health care suicide safe. Washington, DC: Education Development Center, Inc.
Is suicide safety planning different in OUD?
No. Safety planning has elements that are universal to all patients, such as education about suicide warning signs, lethal means reduction, and access to suicide prevention supports, hotlines, and health care. There are also personalized aspects to safety planning. The following are examples of patient-specific planning: determining patient-specific warning signs and patterns, engaging collateral supports from family and peers, working with the person to understand what he or she is willing to do to reduce suicide risk and entering these plans on a pocket reminder, provision of caring outreach contacts, and prescribing medications that target stabilization and reduction of suicide risk (e.g., MOUD for OUD, appropriate antidepressant therapies for depressed individuals).
