The opioid attributable death rate in the U.S. has more than quadrupled over the last 20 years. Simultaneously, suicide has become the 10th leading cause of death and 8th leading cause of death for American Indians and Alaskan Natives. More than 48,000 people die by suicide annually, and it is estimated that for every suicide death there are 25 attempts; clearly indicating many opportunities for prevention. Experts estimate that up to 30% of opioid overdoses are suicides. Those using opioids to manage chronic pain may be at particular risk for opioid-related mortality through intentional or accidental overdose. The Suicide Prevention Resource Center was formed in response to multiple agency recommendations regarding suicide prevention which in turn created the Zero Suicide framework to address suicide prevention in health care settings. The framework is a set of evidence-based approaches for suicide prevention which can be tailored by health care settings. The Mental Health Research Network (MHRN) received funding in 2017 for five years from the National Institute of Mental Health (NIMH) to evaluate the implementation of the Zero Suicide framework across six health systems serving over nine million people (Award # U01MH114087). This evaluation is not focused on understanding the experience of patients who may be at high risk for suicide such as those with diagnosed Opioid Use Disorder (OUD), those without this diagnosis who are using opioids for pain management, and native people. In addition, although providers and health system leaders are involved in the parent NIMH-funded study, we have little information from providers who are treating patients with OUD, using opioids for their patients? pain management, and/or practicing within native communities. We do not know to what extent they have been involved in the Zero Suicide implementation nor their perceptions of its effectiveness. These providers could give clinical and research teams valuable suggestions for tailoring the implementation for high-risk patients. To address these gaps, we propose to incorporate the voice of the patient and provider stakeholders as part of the implementation of the Zero Suicide framework in three health settings from the NIMH-funded parent award as well as the Southcentral Foundation which is an Alaska Native-owned, nonprofit health care organization serving nearly 65,000 American Indian/Alaskan Native people living in and around Anchorage, Alaska. We will test the following aims as part of this proposal:
AIM 1 : Systematically engage patients, providers, national consumer advocacy groups, and MHRN scientists in formulating research questions to address the prevention of opioid-related overdoses in people with OUD or people without diagnosed OUD who are using opioids for pain management;
and AIM 2 : Understand how people with OUD or people without diagnosed OUD who are using opioids for pain management are experiencing the implementation of the Zero Suicide framework in four diverse health systems (Kaiser Permanente Northwest [Oregon] and Southern California, Henry Ford Health Systems [Detroit], and Southcentral Foundation [Anchorage and surrounding communities]).
A recent report from the National Center for Health Statistics found that death from suicide increased from 1999 to 2014 by 24% across all U.S. populations studied and for every suicide death there are 25 attempts; indicating there are multiple opportunities for prevention. Experts estimate that up to 30% of opioid overdoses are suicides; those using opioids to manage chronic pain may be at particular risk for opioid-related mortality through intentional or accidental overdose. We propose to understand the stakeholder perspective on the role of health systems in opioid-related overdoses and involve these stakeholders in all aspects of developing strategies that health systems can use to prevent opioid-related overdoses within the implementation of the national Zero Suicide framework.
