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Innovation Update

Learning about Suicides After Prescription Opioid Change

How will we learn more about the suicides that sometimes happen in the wake of prescription opioid reductions? How can we possibly prevent them? Answering both these questions has been the passion and the commitment of the VA-funded CSI:OPIOIDs team. Let me tell you why we started this work, why it matters, and why it’s difficult to do.

Large database analyses, including those published by VA in 2018, have warned that in some instances, suicides follow prescription opioid reduction or stoppage. It’s tempting to assume cause and effect are fully known, and to jump to conclusions. “Don’t taper too quickly!” “Don’t taper at all!” What’s harder is to ask, with an open mind, what happened and why.

To approach these questions, we decided to study suicides one by one, like airplane crashes. There’s a name for this: “psychological autopsy.” This approach combines interviews and medical record review. The interviews last two hours or more, and cover topics ranging from healthcare changes prior to death, to whether the decedent suffered from unmet social needs from the suicide literature. The latter include two unmet social needs, first described by Thomas Joiner, PhD, a member of our team, and the author of Why People Die by Suicide. One is an unmet need for connection (i.e., “thwarted belongingness”) and the other is a sense that “others would be better if I were gone” (i.e., “perceived burdensomeness”).

Our unique challenge lies with recruitment. Typically, psychological autopsy studies simply ask a medical examiner to help them recruit all suicides in a jurisdiction. By contrast, we seek a type of suicide related to changes in care before death, which is information medical examiners rarely possess. So, our effort is to reach out to the public, to find out if survivors are willing to speak with us on this sensitive subject.

In our pilot work and the first funded year, we developed our own social media, shared across many fora, employed a marketing firm, and designed our website; we’ve also spoken with countless patients and families. Very soon, we’ll launch a professional advertising campaign, working with a firm that understands the rules about what Facebook will and will not agree to share. For example, Facebook will not promote advertisements including the word “suicide.”

At every step, we have learned new things, and we have been fortunate. We’ve had the benefit of VA and non-VA experts in suicide, opioids, pain, addiction, and health services. Even more striking, families who have suffered this excruciating loss have joined our advisory team. If you would like to learn more about our work, please visit www.csiopioids.org. If you know a group of patients or clinicians who would like a flyer,  a presentation, or a link, please let us know by writing to csiopioids@uabmc.edu  and stefan.kertesz@va.gov .