A key measure to reduce suicide risk is safer prescribing in primary and secondary care, particularly opioids prescribed for people with long-term physical illness and benzodiazepines prescribed for people with anxiety disorders. 

With antidepressant treatment there is evidence for a small but significant increase in the presence of suicidal thoughts in the early stages of treatment, but this needs to be balanced against evidence suggesting that the risk of clinically important suicidal behaviour is highest in the month before starting antidepressants. 

Due to this risk several NICE guidelines (including depression in adults, depression in adults with a chronic physical health problem, and depression in children and young people) advise monitoring for suicidal thoughts when antidepressants are prescribed. In people considered at high risk of suicide, and in those under 30 years of age, NICE advises the prescriber should monitor after one week, and frequently thereafter.

Important components of suicide prevention are set out in NICE’s Key Therapeutic Topic, ‘Suicide prevention: optimising medicines and reducing access to means of suicide’, which may include restricting availability of medicines for purchase, prescription and in the home. 

Strategies include prescribing only short-term supplies (e.g. weekly prescriptions). The following list contains other practical actions that could be included in a pharmacy action plan:

• Reminders and reinforcement of limits on OTC analgesic purchase with pharmacy teams
• Closer monitoring where a patient is prescribed more than one medicine known to be commonly used in self-poisoning attempts (e.g. enquiring about opioid-containing analgesics kept at home)
• Reducing stockpiling and actively encouraging return of unwanted medicines to the pharmacy
• Referring patients for review in line with NICE guidance on medicines optimisation.

During the pandemic some GP surgeries temporarily increased the amount of medication supplied on prescriptions to help them and community pharmacies manage workload. In turn some patients will have more medicines in the home and the risk of overdose may be increased.