Tag: decriminalization

Reading of the Week: Fatal Overdoses & Drug Decriminalization – the new JAMA Psych Paper; Also, ChatGPT vs Residents, and Chang on Good Psychiatry

October 5, 2023 /

From the Editor

Does decriminalizing the possession of small amounts of street drugs reduce overdoses? Proponents argue yes because those who use substances can seek care – including in emergency situations – without fear of police involvement and charges. Opponents counter that decriminalization means fewer penalties for drug use, resulting in more misuse and thus more overdoses. The debate can be shrill – but lacking in data.

Spruha Joshi (of New York University) and co-authors bring numbers to the policy discussion with a new JAMA Psychiatry paper. They analyze the impact of decriminalization in two states, Oregon and Washington, contrasting overdoses there and in other US states that didn’t decriminalize. “This study found no evidence of an association between legal changes that removed or substantially reduced criminal penalties for drug possession in Oregon and Washington and fatal drug overdose rates.” We consider the paper and its implications.

In the second selection, Dr. Ashwin Nayak (of Stanford University) and his co-authors look at AI for the writing of patient histories. In a new research letter for JAMA Internal Medicine, they do a head-to-head (head-to-CPU?) comparison with ChatGPT and residents both writing patient histories (specifically, the history of present illness, or HPI). “HPIs generated by a chatbot or written by senior internal medicine residents were graded similarly by internal medicine attending physicians.”

And in the third selection, medical student Howard A. Chang (of Johns Hopkins University) wonders about “good” psychiatry in a paper for Academic Psychiatry. He reflects on the comments of surgeons, pediatricians, and obstetricians, and then mulls the role of our specialty. “I have gleaned that a good psychiatrist fundamentally sees and cares about patients with mental illness as dignified human beings, not broken brains. The good psychiatrist knows and treats the person in order to treat the disease.”

DG

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Reading of the Week: An Exercise App for Burnout – the New JAMA Psych Paper; Also, Pandemic Mental Health Use and Szalavitz on Portugal

September 7, 2023 /

From the Editor

A recent CMA survey found that more than half of physicians report high levels of burnout; surveys of other health care disciplines show a similar result. Not surprisingly, burnout is much discussed. What can be done for health care workers?

In the first selection, Vincent Gosselin Boucher (of the University of British Columbia) and his co-authors consider that question, offering an app-based intervention featuring exercises that can be done at home. The resulting study, just published in JAMA Psychiatry, included 288 health care workers in an RCT. “[A] 12-week app-based exercise intervention yielded significant reductions in depressive symptoms among HCWs that became more pronounced as time progressed.” We review the paper and its implications.

In the second selection, Jonathan H. Cantor (of the RAND Corporation) and his co-authors look at mental health utilization and spending before and during the pandemic, drawing on almost 1.6 million mental health insurance claims in the US. “[U]tilization and spending rates for mental health care services among commercially insured adults increased by 38.8% and 53.7%, respectively, between 2019 and 2022.” 

Finally, in the third selection, author Maia Szalavitz writes about the decriminalization of low-level drug crimes in Portugal. In a New York Times essay, she argues that critics don’t understand what Portugal accomplished – and, in contrast, how many Americans go untreated in correctional facilities. She concludes: “Shifting priorities and funding to provide high-quality treatment and other supports for recovery like housing takes time. Our failure is a century of criminalization – not much-needed attempts to end it.”

DG

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Reading of the Week: Does Opioid Agonist Treatment Save Lives? Also, the Problem with Decriminalization of Illicit Drugs (CJP)

August 5, 2021 /

From the Editor

Methadone was invented in the 1930s. The first legal injection site opened its doors nearly two decades ago. Yet our challenges with opioids seem to have only worsened with time. Consider, for example, that in a new, two-year study, the authors found that opioid-related deaths rose almost 600% between 2015 and 2017 in Canada.

What can we do? This week, we consider two selections.

In the first, Thomas Santo Jr (of the University of New South Wales) and his co-authors do a systematic review and meta-analysis for opioid agonist treatment for those with opioid dependence. They write in JAMA Psychiatry: “Our findings suggest a potential public health benefit of OAT, which was associated with a greater than 50% lower risk of all-cause mortality, drug-related deaths, and suicide and was associated with significantly lower rates of mortality for other causes.” We consider the big paper and its implications.

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And in the other selection, Benedikt Fischer (of the University of Toronto) and his co-authors weigh the recent interest in decriminalizing illicit drug use. In a new Canadian Journal of Psychiatry commentary, they note their hesitation, writing: “while ‘decriminalization’ proposals for illicit drug use are popular and largely well-intended, their overall merits require cautious analysis and scrutiny.”

DG

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