Suicide by poisoning in Australia: patterns of medicine use and targets for means restriction

Abstract

Suicide prevention remains a major health priority, with many risk factors and influences being

complex and varied among individuals. A range of suicide prevention strategies should be used to

address each of these factors, and a knowledge of different suicide methods can help develop

targeted interventions. Recommendations to reduce suicide by poisoning first require identification

of poisons used for suicide in the population. Characteristics and trends of these suicides should also be monitored. Medicines treat medical conditions that pre-dispose suicide risk, while the choice and

availability of medicines has an influence on what medicines can also be used for harm and intentional self-poisoning.

National surveillance data for medicines and substances involved in poisoning suicides often do not provide a greater level of detail than drug class. There are also few studies that investigate both medicines and substances, including alcohol and illicit drugs, that were used preceding suicide at a national level. Identifying both through toxicological analysis can provide a better understanding of how medicines and substances are being used or combined in a high-risk population.

Chapter 2 analysed national means restriction interventions to reduce public access to poisons from a global and historical perspective. The systematic review provided evidence that poisoning suicide rates were reduced by means restriction, with method substitution (other methods of suicide subsequently increasing) being unlikely.

Chapters 3 and 4 identified medicines that were the most likely to be involved in suicides by poisonings. These medicines are recommended targets for means restriction or should be prescribed carefully. This means monitoring or limiting quantities and selecting these medicines as treatment options only after other medicines that are less toxic in overdose have been trialled or considered.