Overdose and suicide are interconnected public health concerns that have risen over the last few decades as the opioid crisis has spread across the nation. Over my career studying these issues, I’ve realized that efforts to jointly address them are limited, greatly inhibiting our ability to see noticeable change. But recent innovations have the potential to bridge that gap.

In 2021, my NORC colleagues and I expanded the evidence-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) model for substance use to include best practices in suicide care. Called SBIRT-Suicide Care (SBIRT-SC), our innovative model simultaneously addresses substance use, overdose, and suicide. To date, we have rolled out SBIRT-SC in New York, North Dakota, Colorado, and Florida.

In 2024, my NORC colleagues and I leveraged this study to dive deeper into potential collaboration between substance use and suicide prevention coalitions. We assessed current activities, needs, challenges, and successes via 16 focus groups with 70 state suicide prevention leads and substance use and suicide prevention coalition leads nationwide. We found that some coalitions successfully collaborated in certain areas, including training, community education, harm reduction, and lethal means safety.

However, they shared several challenges, including limited capacity, an imbalance of funding between coalitions, differential stigma between substance use and suicide, and a lack of specialized education and training. The focus groups made several recommendations for fostering collaboration, including open forums for shared learning and being creative with available funding opportunities.

Both state and coalition leads emphasized the importance of increased communication between the state and their coalitions, including in the development and refinement of state strategic plans and on goals and legislative priorities.

In partnership with the University of North Dakota, we developed and rolled out Suicide Prevention Training and Readiness for Schools (STARS). It consists of three modules:  

1. A leadership workshop to develop joint policies, procedures, and implementation plans
2. An all-staff training to learn warning signs and how to provide a warm handoff to a designated school professional
3. A clinical training on screening and intervention using the SBIRT-SC model

School districts achieve gold, silver, and bronze stars for the number of modules their staff complete, and staff become “STARS-trusted” after completing the training. 

We are now incorporating prescribing social activities into our SBIRT-SC model to address social isolation and loneliness, factors that are closely associated with substance use and suicide. Implementing this model, primary care providers will prescribe social and/or altruistic activities to patients who indicate social isolation and/or loneliness, including tutoring or mentoring students, gardening, exercise classes, fundraising walks, and volunteering at a soup kitchen or animal shelter.

Beginning in rural areas of Western and Central New York, our goal is for statewide expansion, ultimately bringing our efforts to other states across the country.

We also continue to assess deep-rooted stigma toward addiction, mental health, and suicide in rural areas—including how it manifests at the individual, social, and societal levels—and identify ways to better support communities. For example, we’ve found that nonclinical professionals (e.g., faith-based leaders, school personnel, and first responders) are taking on increasing responsibilities in overdose and suicide prevention given stigma-related hesitancy to seek help, and it is critical they receive proper education, training, and support.

Last, we are tailoring our SBIRT-SC model for 988 suicide and crisis contact centers. There is currently no standard protocol or required training in substance use for 988 counselors; this is a critical gap given its close connection with suicide and that substance use is one of the reasons people are encouraged to contact 988 in the first place. Our goal is to pilot SBIRT-SC with several contact centers, adjusting the approach to maximize impact before a larger-scale rollout.

We continue to innovate on ways to jointly address overdose and suicide given evolving needs, challenges, and opportunities. Our novel approaches for addressing overdose and suicide have been informed by the communities we serve, and these efforts have received strong support from health care organizations, schools, community-based organizations, crisis centers, and local and state governments. Because the work starts with partners ready and able to test novel ideas and models, we have engaged key partners in an advisory capacity and are exploring policies, regulations, and practices that will support sustained implementation.