A Stepwise Approach for Preventing Suicide by Lethal Poisoning.

backgroundSuicide is a global phenomenon and is the 10th leading cause of death in the US. Veterans are more likely to die by suicide than those in the general population. In 2018, the suicide rate for all US veterans was 1.5 times higher than the rate for nonveterans, after adjusting for population differences in age and sex. In light of this disparity, suicide prevention is one of the highest priorities for the US Department of Veterans Affairs (VA). One major goal of the VA suicide prevention strategy is to reduce access to lethal means. OBSERVATIONS: This article will provide information on medications with high lethality and a stepwise approach for how health care providers may limit lethal medications for patients at high risk for suicide. The first step is to determine suicide risk. More than 90% of those who die by suicide have a psychiatric diagnosis at the time of death. Clinicians can use risk assessment tools, such as the Veterans Health Administration Suicide Prevention Population Risk Identification and Tracking for Exigencies tool. The second step is to identify substances strongly associated with fatalities. According to the American Association of Poison Control Centers, the pharmaceutical classes associated with the largest number of fatalities are stimulants and street drugs, followed by analgesics, cardiovascular agents, antidepressants, antipsychotics, and sedatives/hypnotics. The third step is to consider potential drug-drug interactions, such as the combination of opioids and sedative-hypnotics. Finally, clinicians need to address risks. With high-risk patients it may be preferential to prescribe medications that are less lethal. All patients with a high risk of suicide should receive lethal means counseling.

conclusionsWhile firearms continue to be the most lethal means for veteran suicide, intentional poisoning with medications or substances also is a common method for suicide, especially for female veterans. Having knowledge of medications with high lethality and limiting access to these agents can be a successful strategy for reducing suicide deaths.