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Acute suicidal ideations responsive to hydromorphone
  1. James Kimber Rotchford
  1. Olympas Medical Services, Port Townsend, Washington, USA
  1. Correspondence to Dr James Kimber Rotchford, JKRotchford{at}


A 72-year-old woman with suicidal ideations for the first time was seen for a follow-up medical visit. Patient diagnosed with bipolar disorder II, chronic complex pain and other complex medical issues. Patient was on long-standing chronic opioid agonist therapy. Patient was prescribed oral hydromorphone to supplement her chronic opioid regimen. Within 24 hours, the patient reported no further suicidal ideations and there were no reported complications. The case provides impetus for further study as to what interventions work best for patients who present with acute suicidal ideations. The case acknowledges cultural issues and implicit biases that can influence medical care and perceptions thereof. Implicit biases may be particularly apparent as they relate to mental health concerns and the use of substances that are susceptible to abuse. The most important clinical lesson reminder may be the importance of adequate documentation and discussion be provided when one prescribes an opioid in a novel way in a special clinical context.

  • psychiatry (drugs And Medicines)
  • pain (neurology)
  • therapeutic indications
  • mood disorders (including depression)
  • suicide (psychiatry)

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  • Contributors This case report was written entirely by JKR and was based on a long-standing therapeutic relationship with the patient. There were no other contributors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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