Access to Firearms and Opioids Among Veterans at Risk for Suicide.

Importance: Firearm injury and poisoning, often by drug or medication overdose, account for most suicides among the general population and US veterans. In the Veterans Health Administration, the largest integrated health care system in the US, firearm and opioid access is assessed among patients at risk for suicide who complete suicide safety plans. Objective: To describe self-reported, clinician-documented access to firearms and opioids, firearm storage practices, distribution of firearm cable locks and naloxone, and counseling on firearm storage and overdose among veterans at elevated risk for suicide who completed suicide safety plans. Design, Setting, and Participants: This cross-sectional study used electronic health record data from the Veterans Health Administration from December 2021 to February 2023. Participants were veterans identified as having elevated suicide risk through routine screening with the Columbia Suicide Severity Rating Scale Screener who completed a safety plan within 30 days. Data were analyzed from March 2023 to March 2024. Exposure: Completion of a safety plan, a brief, evidence-based intervention to help prevent or de-escalate suicidal crises. Main Outcomes and Measures: Firearm and opioid access, as well as firearm storage information, were assessed via the lethal means component of the standardized safety plan note template. Results: Among 38 454 veterans identified (32 310 [84.0%] male; 15 206 participants [39.5%] aged ≥55 years; 26 960 participants [70.1%] living in urban areas), 9969 (25.9%) were Black and 23 714 (61.7%) were White and 3426 (8.9%) were Hispanic/Latine and 28 892 (75.1%) were not Hispanic/Latine. A total of 10 855 (28.2%) reported access to firearms. Approximately one-third of veterans reported storing at least 1 firearm in each of the following ways: unlocked and loaded (insecure), outside of the home or locked and unloaded (secure), or locked and loaded. Younger and middle-aged veterans, White veterans, veterans who were not Hispanic/Latine, male veterans, and rural veterans were more likely to report firearm access. A total of 2021 veterans (5.3%) reported access to opioids; older veterans, White veterans, veterans who were not Hispanic/Latine, and rural veterans were more likely to report opioid access. Clinicians reported discussing firearm storage with 10 655 veterans (98.2%) and overdose with 1589 veterans (78.6%). Only 1837 veterans (16.9%) offered firearm cable locks and 536 veterans (26.5%) of veterans offered naloxone were documented as accepting them. Conclusions and Relevance: In this cross-sectional study of electronic health record data, the prevalence of reported access to firearms was lower than expected, suggesting underreporting or underdocumentation, or a lower true prevalence among this at-risk population. Completion of a note template may have encouraged routine discussion of firearm storage and overdose risk, but acceptance of gunlocks and naloxone was low. These findings suggest that White veterans, veterans who were not Hispanic/Latine, and rural veterans may be at particular risk of harm by firearms and opioids.