Self-poisoning is the second most common method of suicide in the UK after hanging, suffocation or strangulation. Medicines used in a self-poisoning attempt may have been prescribed (e.g. for long-term pain) for the patient, for someone else in their household or bought over the counter in a pharmacy or other retail premises. 

Reducing access to means of suicide is a key consideration in suicide prevention. Consider that in fatal overdoses:

• 33 per cent used opioids
• 11 per cent antipsychotic drugs
• 9 per cent tricyclic antidepressants
• 9 per cent selective serotonin re-uptake inhibitors (SSRIs) or serotonin and noradrenaline re-uptake inhibitors (SNRIs)
• 7 per cent paracetamol and opioid combinations
• 7 per cent non-opioid analgesics (mostly paracetamol)
• 3 per cent pregabalin
• 2 per cent gabapentin.

Almost four in 10 suicidal patients who have a physical health problem die by self-poisoning, which is significantly more than patients without a physical co-morbidity. The most common substances taken in this group are opioids (mostly prescribed).  

Benzodiazepines were mentioned on the death certificate in 406 cases (11 per cent) of the 3,744 self-poisoning deaths in 2016 in England and Wales. The potential risks of suicide associated with benzodiazepine prescribing and withdrawal increase the need for continued alertness from community pharmacists. 

People who are receiving benzodiazepines for extended periods of time should be regularly reviewed by their prescriber so that their suitability for long-term prescribing can be assessed. Best practice in the management of benzodiazepine withdrawal is set out in NICE’s Clinical Knowledge Summary (CKS) on benzodiazepine and z-drug withdrawal.