![]() The CHRT-SR was also used to create a binary indicator of suicidality if a participant responded “Yes” to any of the three following items indicative of suicidal thoughts: “I have been having thoughts of killing myself”, “I have thoughts about how I might kill myself”, or “I have a plan to kill myself”. Responses are measured by a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5), with total scores ranging from 12 to 60. Items assess signs and symptoms, including characteristics such as pessimism, lack of social support, helplessness, and despair the last three items assess active suicidal ideation and behavior. The independent variable analyzed as the predictor was the baseline suicidality score as measured by the 12-item CHRT-SR that evaluates suicide propensity, ideation, and intent. ![]() While these are important contributions that have brought attention to suicidality as an overdose risk factor, these analyses have been limited to single-site or single system studies, have focused on small samples of OUD patients with self-reported intentionality and outcomes, and have been constrained by patient recall. Because suicidal ideation and intent may underlie many overdose events, studies have shed light on the importance of further characterizing overdose events with the final goal of deploying specific prevention strategies to individuals with suicidal risk and intent. Suicidal thoughts might increase the risk of non-fatal overdose and potentially elevate the risk for future intentional overdose or unintentional overdose. With the goal of better understanding and preventing opioid overdose and overdose fatalities, recent literature has drawn attention to the distinction between intentional and unintentional overdoses among opioid users. Suicide is the 10th leading cause of death in the United States and is a contributor to premature mortality. Response to the marked rise in overdose deaths should integrate suicide risk reduction as part of prevention strategies. Participants with lifetime heroin use were more likely to overdose (OR 3.08). ![]() CHRT-SR score was associated with overdose events ( p = 0.03) during the trial the likelihood of overdose increased as continuous CHRT score increased (OR 1.02). Multivariate logistic regression was performed to assess continuous CHRT-SR score as a predictor of overdose, controlling for covariates. Overdose events were determined by reports of adverse events, cause of death, or hospitalization due to substance overdose, and verified through a rigorous adjudication process. The trials assessed baseline suicidality with the Concise Health Risk Tracking Self-Report (CHRT-SR). ![]() The current research evaluated suicidality as a predictor of overdose events in 2541 participants who use substances enrolled across eight multi-site clinical trials completed within the National Drug Abuse Treatment Clinical Trials Network between 2012 to 2021. However, this research has been limited to single site studies of self-reported outcomes. Research has examined co-occurring mental health conditions, including suicidality, as a risk factor for intentional and unintentional overdose among individuals with substance use disorder (SUD). Increasing rates of overdose and overdose deaths are a significant public health problem.
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