Multiple studies have documented the link between the presence of chronic pain and risk of suicide, with higher severity of pain predicting greater likelihood of suicide. The concern that opioid tapering or discontinuation may further exacerbate the risk of suicidal ideation, suicide attempts, and suicide deaths has received great attention. For the US, the age-adjusted rate of deaths from suicide and unintentional overdose has more than doubled between 2010 and 2017. It is estimated that about 20% to 30% of opioid overdose deaths are intentional, and the rate of suicides could be even higher. Suicide is now the 10th leading cause of death, accounting for more than 48,000 deaths in 2018, with Veterans accounting for approximately 17.6 suicide deaths every day. Suicide prevention is of highest priority to the Veterans Health Administration (VHA). This course describes factors contributing to suicide risk and how to reduce it in a pain clinic setting. We will focus on the care of the patient with high impact pain, with particular attention to opioid therapy, dosage reductions, and discontinuations. Best practices from VHA, including system-wide reviews of patients at high risk that have reduced mortality, will be used to help pain clinicians identify patients at risk, through screening at intake evaluations and by leveraging predictive analytic tools.