Standardizing provider assessments reveals important information about gun and opioid access for veterans at risk of suicide

(Press-News.org) PHILADELPHIA—Standardizing an assessment process currently used by doctors during care discussions with veterans at risk for suicide in other context could shed more light on the risks related to firearms and opioids.  

The findings from researchers at the Perelman School of Medicine at the University of Pennsylvania were reported today in JAMA Network Open. They found that fewer veterans reported having access to firearms than expected—either because some didn't mention it to their doctor, it wasn't recorded by the provider, or because the true prevalence is lower among this high-risk group.

The research was led by Gabriela Khazanov, PhD, a research associate with the Penn Center for Mental Health and research psychologist with the Corporal Michael J. Crescenz VA Medical Center (VA). 

“Veterans have high rates of firearm ownership but may not always share this with their provider as part of suicide safety planning,” Khazanov said. “Some may worry, incorrectly, that their firearms would be confiscated, or their care would be impacted in some way, highlighting the importance of explaining the rationale for these discussions and describing any potential consequences, however unlikely, of firearm disclosure.”  

Among veterans, firearm injury accounts for 72 percent of suicides and poisoning, typically by overdose, accounts for 8 percent of suicides among veterans, respectively, with suicides due to opioid overdose nearly tripling over the last 20 years.  

The team reviewed health records of 38,454 veterans at risk for suicide receiving suicide safety plans in the VA—a brief, evidence-based intervention that helps patients identify strategies to prevent or de-escalate suicidal crises. One-third of veterans with access to firearms reported storing at least one firearm insecurely and only one-third of veterans with access to opioids accepted naloxone, an overdose-reversing drug. In addition, researchers found that only 5 percent of veterans included reported having access to opioids. 

Doctors did report addressing firearm safety with 98 percent of veterans with access to firearms and discussing overdose risks with 79 percent of veterans with access to opioids. 

“Veterans may have underreported access to opioids when discussing higher suicide risk due to concerns that their access to prescribed opioids would be limited,” Khazanov said.  

Researchers noted that while the study’s relative size was a strength, further study and discussion is necessary on socioeconomic and demographic differences when leading these discussions.  

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Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the University of Pennsylvania Health System and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.

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