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Prescribed access to psychotropic drugs linked to suicide method choice

Individuals using a psychotropic medication in a suicide attempt were significantly more likely to have had been prescribed access to that medication than those not using any psychotropic drug, according to data published in The Journal of Clinical Psychiatry.

“A majority of suicide attempts involve the use of medication. There is some evidence that removing access to a preferred method can thwart an attempt and increase the opportunity to get suicidal individuals help,” Talia L. Brown, PhD, from Boulder County Public Health and the Colorado School of Public Health, told Healio Psychiatry. “This study is important because psychotropic medications are so commonly prescribed, so there is the opportunity for a clinician or pharmacist to intervene.”

Using a case-control study design, researchers examined whether prescribed access to any psychotropic medication increased the probability of using a psychotropic drug to attempt suicide and whether prescribed access to a specific psychotropic drug type was tied to using that specific drug type in an attempt.

The investigators reviewed relevant ICD-9-CM codes from a U.S. insurance claims dataset to identify people receiving care for both fatal and nonfatal suicide attempts in ED and inpatient settings between 2006 and 2013. The main exposure was individuals who filled a psychotropic drug prescription within 90 days before the suicide attempt, and the researchers compared cases that used a psychotropic drug in their suicide attempt with controls who used another method.

Overall, 10,158 individuals used any psychotropic medication in their suicide attempt and 17,718 used other methods. Brown and colleagues found that 18% of the study sample had been prescribed access to any psychotropic drug in the 90 days before a suicide attempt. Anxiolytics were the most commonly used psychotropic medication in an attempt (59.4%), followed by antidepressants (35.2%), antipsychotics or mood stabilizers (11.5%) and stimulants (3.6%). In addition, 1,316 cases (13%) used more than one type of psychotropic in the attempt.

Multivariable logistic regression analysis revealed that people using a psychotropic drug in a suicide attempt were more likely to have had prescribed access (adjusted OR = 1.7; 95% CI, 1.6-1.9) across all psychotropic drug groups evaluated. For each specific psychotropic drug, analysis showed a significant positive relationship with prescribed access to that drug class; the strongest connections were observed for antipsychotics/mood stabilizers (aOR = 6.5; 95% CI, 5.4-7.7) and stimulants (aOR = 7.6; 95% CI, 5.5-10.5).

“The take home message is for clinicians to consider safety interventions when prescribing psychotropic medication to potentially suicidal patients,” Brown told Healio Psychiatry. “This can include prescribing less toxic medication where possible, prescribing medication dispensed in blister packs, reducing the number of pills dispensed at a given time, and working with friends and family to lock up medications.” – by Savannah Demko