Emergency Psychiatry

Journal Article Annotations
2023, 4th Quarter

Emergency Psychiatry

Annotations by Clayton Barnes, MD, MPH
January, 2024

  1. Patients’ Perspectives on Medication-Related Suicide Prevention Interventions Delivered in Emergency Settings.

Of interest:

PUBLICATION #1 — Emergency Psychiatry

Patients’ Perspectives on Medication-Related Suicide Prevention Interventions Delivered in Emergency Settings.
Joseph A Simonetti, Ryan Holliday, Joseph Mignogna, Suzanne Thomas, Alexandra Smith, Marian Betz, Lisa A Brenner, George Sayre.


The finding:
The investigators interviewed 28 at-risk veterans to identify opinions, barriers, and facilitators to medication-related suicide prevention strategies. In general, the subjects expressed little awareness of any of the discussed interventions: return envelopes, lockboxes, disposal bins, limited prescriptions, and naloxone distribution. Medication return envelopes were repeatedly cited as the most acceptable intervention while limiting prescription refills and dispense numbers were least supported by participants. Interestingly, participants with lived experience of opioid use expressed an appreciation for safety and prevention strategies.

Strength and weaknesses:
Study subjects were predominantly white, heterosexual, cis-gendered, male veterans receiving care within the Mountain West Veterans Health Administration; it is unclear to what extent these results can be generalized to other geographic regions or civilian and LGBTQ+ populations. It is important to note that although females are most affected by medication overdose behaviours, this demographic group provided only 14% of study responses. Finally, participants were provided a $40 incentive to participate; although a relatively small reward, financial compensation is a strategy known to potentially bias study populations. Despite these limitations, this study provided a notable advancement in the suicide prevention literature.

If the reflections offered by subjects in this study are representative of patients generally, individuals at risk of suicide may not fully appreciate their risk, limiting their engagement with interventions. As individual practitioners, C-L psychiatrists must provide sufficient education to patients to ensure awareness of why prevention interventions may be necessary. Framing interventions as helpful in addressing multiple negative outcomes (theft, access by children, unintentional overdose, etc) may be key to facilitating adherence. Personalizing the importance of prevention interventions – an insight garnered from the patients with opioid use history in this study – may also improve adherence to interventions. This study has important implications for both health systems and individual providers working to prevent suicide. Systems must make medication-related suicide prevention strategies cost-effective, easily accessible, and accommodating of patient mobility issues.

PUBLICATION #2 — Emergency Psychiatry

The emerging fentanyl–xylazine syndemic in the USA: challenges and future directions.
David T Zhu, Joseph Friedman, Philippe Bourgois, Fernando Montero, Suzanne Tamang.

Annotation (unstructured)

CL and emergency psychiatrists best support patients when they are aware of local and national public health trends. Xylazine is a veterinary alpha-2-agonist tranquilizer increasingly being found as an adulterant in the fentanyl supply. This article highlights the social determinants that place an already disenfranchised community at further risk and outlines steps to monitor and curtail the emerging crisis. Additionally, those at the intersection of psychiatric, addiction, and medical care should be aware of the implications of Xylazine adulteration, including the lack of efficacy of naloxone, as well as prolonged sedation and a unique withdrawal syndrome.