Feasibility and acceptability of safety screening among patients receiving addiction treatment

Premature mortality associated with opioid-related overdose and suicide is a significant public health problem in the United States. Approximately 20-30% of individuals with opioid use disorder (OUD) have a history of both suicide attempt and unintentional opioid overdose. The objective of this study is to evaluate the feasibility of a standardized screen for suicide and overdose among patients receiving addiction treatment.

We conducted a cross-sectional study using a convenience sample of patients (n = 113) recruited from two inpatient treatment programs. We used a modified version of the Patient Safety Screener (mPSS) to screen for suicidal ideation, suicide attempt, and overdose. Study staff administered the screen in-person during treatment, and we linked results to administrative clinical data. Subjects (n = 108) and members of their clinical care team (n = 20) completed a screening acceptability survey. We recorded a positive mPSS if a patient reported suicidal ideation in the past two weeks, a suicide attempt, and/or an overdose in the past six months.

Fifty-eight percent of subjects had a positive mPSS screen, and 30.3% reported suicidal ideation, suicide attempt, and overdose. Subjects and clinical staff reported that it was acceptable to screen for suicide attempt(s) and overdose(s). About a third of the clinical staff reported concerns about administration time (n = 7) and impact on workflow (n = 6).

Both suicide and overdose are important patient safety factors that should be incorporated into addiction treatment and discharge planning. This study's findings support simultaneously screening for suicide and overdose in OUD inpatient treatment settings. Future research needs to determine whether screening improves provision of services and reduces self-injurious behavior.