Tailored to the medication
Each medication gets questions that fit what it can do and what to watch for.
Medication Safety
Medication safety that happens in real life, not just on a leaflet.
Some medications carry boxed warnings about serious risks, including suicidal thoughts. The Medication Safety module is planned to turn those warnings into check-ins, a circle of people who are told when something is wrong, and a plan everyone can follow, with the goal of preventing medication-related suicide.
PlannedIn design — not available yet.
The idea
A boxed warning is a paragraph. Safety is what happens next.
A boxed warning is the FDA’s most prominent warning (FDA). Some medications carry boxed warnings about serious mental health risks, including suicidal thoughts.
For example, all antidepressants carry a boxed warning about increased suicidal thinking and behavior in children and adolescents. It says patients who start therapy should be observed closely, and that families and caregivers should be advised to observe closely and communicate with the prescriber. In the studies behind it, the risk was greater during the first few months of treatment (FDA). In 2020, FDA required a boxed warning on montelukast (Singulair and generics) for serious mental health side effects, including suicidal thoughts or actions (FDA).
“Observe closely” is hard to do alone, especially with a brain injury, memory problems, or cognitive load. The Medication Safety module is meant to make it something that actually happens — with the goal of preventing medication-related suicide.
A warning isn’t a reason to stop
A boxed warning doesn’t mean a medication is unsafe for everyone, and many people benefit from them. Never start, stop, or change a medication or dose because of anything on this site. Talk to your prescriber or pharmacist.
How it works
Four steps, built around you.
Add a medication
A new prescription, or one you already take. It can come from your profile or from you.
Get check-ins that fit
Questions tailored to that medication and to the key issues in your profile.
Choose your circle
Pick the people who are told if something is wrong, and what to do.
Follow the plan together
If your medication or care team calls for extra safety steps, the module walks you and your circle through them.
Check-ins
Often at the start. Monthly after that.
| Situation | How often | What it does |
|---|---|---|
| A new medication | Up to two times a day | Asks questions tailored to that medication and to the key issues in your profile, until you’re out of the risk window for that medication. |
| Once you’re out of the risk window | Monthly | Moves to monthly check-ins. |
| An ongoing medication | Monthly | Checks how the medication is acting over time. Medications can act differently when the brain changes — for example with age — so people at risk of those changes get questions that reflect them. |
The risk window is different for each medication. We’ll publish the window we use for each one, and where it comes from.
Tailored to your profile
The key issues in your profile shape the questions. For example, a brain injury, a seizure disorder, or sleep problems.
Kept easy
Short, plain-language questions, because cognitive load is real.
Examples of what a check-in might ask about7 examples
- Sleep
- Agitation or irritability
- Mood
- Impulsivity
- Dizziness or balance
- New thoughts of self-harm
- Whether you’ve taken the medication as prescribed
These are examples, not the final questions. Before launch, the questions and alert rules for each medication will be reviewed by qualified clinicians.
Your risk circle
People who are told when something is wrong.
You choose who’s in your circle — your parents, your spouse, or anyone else you trust. If a check-in suggests something is wrong, they’re notified, and told what to do.
- You choose who, and what each person is told.
- You choose what triggers a notification.
- Each person sees only what you’ve chosen to share with them.
- You can change your circle, or turn notifications off, at any time.
What to do is tailored too
What a circle member is asked to do can differ by medication and by person: for example, checking in by phone, staying with you, or helping with safe storage. They get plain steps, not medical jargon.
The plan
When a medication calls for extra safety, everyone gets a plan.
Some medications, and some situations, come with advice to take extra precautions — especially in the first days and weeks, as a dose ramps up. If your prescriber or care team recommends it, the module walks you and your circle through the steps.
- Not being alone during the ramp-up, with a schedule of who is with you and when
- Safely storing, or temporarily removing, firearms
- Keeping only a small supply of medication on hand, with a pharmacist’s guidance
- Who to call, and when: your prescriber, 988, or 911
These are examples, not recommendations. Your plan follows what your prescriber and care team advise.
Why this matters
VA describes lethal means safety — putting time and space between a person in crisis and a method — as an evidence-based part of suicide prevention, including for firearms and medications (VA).
VA’s recommendations also note that state and federal laws limit some personal firearm transfers, and that firearms shouldn’t be handed to someone who is themselves at risk (VA). Check the rules where you live before transferring a firearm.
Optional
Share your level, if you choose.
In certain situations you can also choose to share your risk level with local first responders. Your circle can follow along in BT22 Live, a dashboard that shows who might need support, early.
Planned
What it is not
Support for a safer start — not a prescriber.
- It does not prescribe anything, or tell you to start, stop, or change a medication or dose.
- It does not diagnose. A risk level is not a prediction that someone will or won’t attempt suicide.
- A check-in can miss things. A quiet day isn’t a guarantee of safety.
- It is not 911 or 988, and it doesn’t replace your prescriber or pharmacist.
- It is not available yet.
If you’re in crisis right now
Call or text 988, then press 1, or chat at veteranscrisisline.net. For a medical emergency, call 911.
Before it launches
What we’ll publish first
We’ll publish how Medication Safety works before anyone is asked to use it: the questions and schedule for each medication, what triggers a notification, who sees what, and how the medication information was reviewed. Before launch, the questions and alert rules will be reviewed by qualified clinicians.
Want to hear when it’s ready, or help shape it — including as a prescriber, a pharmacist, or someone who has been through this? Email research@behindthe22.com.
Want to hear when Medication Safety opens? Start with a free screener, or tell us what you’d want from it.