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Simonetti JA, Holliday R, Mignogna J, Thomas S, Smith A, Betz M, Brenner LA, Sayre G. Patients' Perspectives on Medication-Related Suicide Prevention Interventions Delivered in Emergency Settings. Psychiatr Serv 2024; 75:275-282. [PMID: 37933134 DOI: 10.1176/appi.ps.20230178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Encouraging patients at risk for suicide to reduce access to potentially lethal medications and drugs is a key component of evidence-based suicide prevention. However, little research has been done to inform interventions for reducing intentional self-harm. METHODS Semistructured interviews were conducted with 28 U.S. veterans who sought emergency care from the Veterans Health Administration between 2021 and 2023 to explore veterans' perspectives on medication-related interventions, including opinions on intervention components (e.g., medication return envelopes). Matrix analysis was used to aggregate data into categories, which were predefined by using constructs from the health belief model (e.g., perceived benefits). RESULTS The participating veterans generally endorsed interventions as acceptable and were particularly supportive of distributing medication return envelopes. However, they often conceptualized these efforts as steps to prevent unintentional overdose or theft-not necessarily to prevent suicide-and rarely indicated that such interventions were appropriate for themselves. Across the interviews, participants identified important facilitators to care, such as ensuring that interventions were convenient and accounted for the perceived cost of disposing medications. Perspectives on engaging family or friends in interventions were mixed. The importance of the interventions was more readily acknowledged among participants with previous opioid use exposure-perspectives that appeared to stem from lived experiences. CONCLUSIONS This study contributes important foundational knowledge that can be used to inform research and clinical initiatives aimed at preventing medication- and drug-related suicides.
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Affiliation(s)
- Joseph A Simonetti
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
| | - Ryan Holliday
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
| | - Joseph Mignogna
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
| | - Suzanne Thomas
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
| | - Alexandra Smith
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
| | - Marian Betz
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
| | - Lisa A Brenner
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
| | - George Sayre
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
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Nesoff ED, Meisel ZF, Saeed H, Martins SS. Neighborhood and Individual Disparities in Community-Based Naloxone Access for Opioid Overdose Prevention. J Urban Health 2024; 101:64-74. [PMID: 38196059 PMCID: PMC10897088 DOI: 10.1007/s11524-023-00821-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
Improving access to naloxone for laypersons is a cornerstone of the US strategy to reduce opioid overdose deaths. This study evaluated change in distance to opioid overdose prevention programs (OOPPs) providing walk-in naloxone across two time points. We also explored individual and neighborhood disparities in distance to OOPPs, associations between 2020 OOPP locations and 2018 overdoses, and associations between OOPPs and neighborhood fatal overdose rates. Using fatal opioid overdose locations in 2018 (n = 1167) and 2020 (n = 2045) in New York City, we mapped OOPP locations and fatal overdose locations to visualize areas of unmet naloxone need. We used logistic regression to assess individual (age, sex, race/ethnicity) and neighborhood correlates of odds of an overdose occurring within walking distance (≤ 0.5 miles or 0.8 km) of an OOPP and negative binomial regression to assess the relationship between census tract-level OOPP counts and overdose rates. Distance to OOPPs significantly improved over time, with average distance decreasing by 1.7 miles (2.7 km) (p < 0.001). OOPPs were more likely to be located in neighborhoods with higher poverty in both years and in closer proximity to Latinos in 2020-suggesting improved access for Latinos and in higher poverty neighborhoods. OOPP locations in 2020 were significantly positively associated with overdose locations in 2018. OOPPs were not well-situated in neighborhoods with elevated overdose rates in 2018 but were better situated in 2020, controlling for other neighborhood variables. Community lay naloxone access through OOPPs improved over time and could have promising effects for improved overdose rates in the future.
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Affiliation(s)
- Elizabeth D Nesoff
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, 423 Guardian Dr, Philadelphia, PA, 19104, USA.
| | - Zachary F Meisel
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, 423 Guardian Dr, Philadelphia, PA, 19104, USA
| | - Huda Saeed
- Brown University, 75 Waterman Street, Providence, RI, 02912, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W168th St, 5th Floor, New York, NY, 10032, USA
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