Suicide Screening and Risk Assessment in the Emergency Department: Case Review of a Suicide Attempt Survivor.

One in 10 of those who die by suicide are seen in an emergency department within the 2 months before their death. Despite national guidelines and resources (including from the Joint Commission and Emergency Nurses Association) for suicide screening, risk assessment, and follow-up care, suicidal ideation and behavior continue to go undetected in emergency departments, leading to gaps in care. This case review was conducted as part of a larger electronic medical record review of emergency department practices and aims to highlight potential gaps in care and identify missed opportunities for suicide screening and risk assessment. In addition to highlighting these missed opportunities, this case review provides recommendations for suicide screening and risk assessment resources with options for evidence-based follow-up care for suicidal patients.

Adjunct interventions to standard medical management of buprenorphine in outpatient settings: A systematic review of the evidence.

BACKGROUND: A growing body of research has examined adjunctive interventions supportive of engagement and retention in treatment among patients receiving buprenorphine for opioid use disorder (OUD). We conducted a systematic review of the literature addressing the effect on key outcomes of adjunctive interventions provided alongside standard medical management of buprenorphine in outpatient settings. METHODS: We included prospective studies examining adults receiving buprenorphine paired with an adjunctive intervention for the treatment of OUD in an outpatient setting. Data sources included Medline, Cochrane Central Register of Controlled Trials, CINAHL and PsycINFO from inception through January 2020. Two raters independently reviewed full-text articles, abstracted data and appraised risk of bias. Outcomes examined included abstinence, retention in treatment and non-addiction-related health outcomes. RESULTS: The final review includes 20 manuscripts, 11 randomized control trials (RCTs), three secondary analyses of RCTs and six observational studies. Most studies examined psychosocial interventions (n = 14). Few examined complementary therapies (e.g., yoga; n = 2) or technological interventions (e.g., electronic pill dispensation; n = 3); one study examined an intervention addressing structural barriers to care (patient navigators; n = 1). Low risk of bias RCTs found no evidence that adding psychosocial interventions to buprenorphine treatment improves substance use outcomes. CONCLUSIONS: Research is needed to identify adjunctive interventions with potential to support medication adherence and addiction-related outcomes for patients engaged in buprenorphine treatment. Data from clinical trials suggest that lack of ready access to psychosocial treatments should not discourage clinicians from prescribing buprenorphine.