[DanBC]

National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (UK): http://www.bbmh.manchester.ac.uk/cmhs/research/centreforsuic...

That paper tells us that pain medication is often used in completed suicide (paracetamol; paracetamol and opioids combined; and opioids; are three of the top five most commonly used meds)

So I have an interest in pain medication from the angle of suicide prevention, which is why these two are interesting.

Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials: http://www.bmj.com/content/350/bmj.h1225

(Paracetamol probably doesn't help with long term musculo-skeletal pain, and increases risk of liver damage)

http://www.thelancet.com/journals/lancet/article/PIIS0140-67...

(Paracetamol probably no better than placebo for long term back pain)

[MichaelGG]

It's a bit confusing. For instance around page 80:

Table 5: Male suicide deaths and those aged 45-54 in the general population, by UK country vs Table 7: Patient suicide: male suicide deaths and those aged 45-54, by UK country.

Table 5 shows the rate. Table 7 shows the actual numbers. Why? Even the first key finding speculates about patient suicide increase due to higher numbers of patients. Do they not have this seemingly important statistic? A quick search says "a quarter" of the population will have a mental illness during the year. If true, then we'd expect around 25% of suicides to be from patients, right?

Why separate the APAP/opiod combination in light of suicide if the APAP wasn't a relevant cause? It seems like respiratory depression and liver poisoning aren't that synergistic are they? An opiate naive user with 10/325 oxy/apap would almost certainly hit opiate overdose before liver damage was a life-threatening issue.

The study recommends "safe prescribing" but then shows the majority of opiate suicide isn't with a prescription, and prescription overdose is skews heavily to older females with a "major physical illness". And no comparison on how rx abuse compares with non-mentally-ill patients. Edit: And rx rates, too. I'm guessing older patients generally get way more opiates prescribed than younger ones.

Interesting read though, thanks.

[DanBC]

These are great questions. They're normally pretty good at responding if you want more information.

Here "patient" means "under the care of secondary MH services", so doesn't include people who are being treated by their GP rather than by eg a community MH team.

I think the opioid / APAP stuff is based on bots of history. Co-Proxamol was for years the most common med used in completed suicide. It was put on more restrictive prescribing, and use dropped. But then plain paracetamol use in completed suicide increased. (And also attempted suicide, for a while paracetamol overdose was 4% of UK liver transplants, (but 25% of the super-urgent transplants)). Rules about paracetamol tightened, so we've seen reductions in its use. So, from a public health POV, it's useful to see if plain paracetamol, or the combination, or plain opioids are being used more often, because that means they can look at what's driving sales or prescriptions.

About safe prescribing: one source of medication used in completed suicide is either from your own prescription, or from a relative's prescription. This is often a preventable cause of death, so it's useful to see if safe prescribing helps. It ties into things like "Triangle of Care" and also "Pills Project" (which I want to try to use outside care homes).

You're right about older people. They also often don't lock up the meds in a cupboard (they don't have children in the home anymore, they don't see a need) and tragically grand-children come to visit and accidentally overdose.

https://www.carers.org/triangle-care

http://www.health.org.uk/pills