Tag: Opioid Agonist Treatment

Reading of the Week: IPT for Depression in Pregnancy – the New JAMA Psych Paper; Also, Treating Opioid Use (JAMA) and Substance Ed for Docs (Wash Post)

June 22, 2023 /

From the Editor

Prenatal depression affects two: the mother and her fetus. But how to effectively address depressive symptoms?

In the first selection, from JAMA Psychiatry, Benjamin L. Hankin (of the University of Illinois at Urbana-Champaign) and his co-authors consider a focused psychotherapy for that population. In a RCT involving 234 participants, they find that IPT was helpful. “Brief IPT significantly reduced prenatal depression symptoms and MDD compared with EUC [enhanced usual care] among pregnant individuals from diverse racial, ethnic, and socioeconomic backgrounds recruited from primary OB/GYN clinics.” We look at the paper and its clinical implications.

In the second selection, Caroline King (of the Oregon Health & Science University) and her co-authors consider buprenorphine for opioid use disorder with a focus on adolescent residential treatment. In a JAMA research letter, they report the findings which included every identified facility in the United States. “In contrast to the standard of care, only 1 in 4 US facilities offered buprenorphine and 1 in 8 offered buprenorphine for ongoing treatment.”

And, in the third selection, former AMA president Dr. Patrice A. Harris (of Columbia University) and her co-authors argue that physicians should know more about addiction treatment. In a Washington Post essay, they argue for more robust training. “Opioid use disorder is treatable, and medicines are readily available. But doctors cannot learn to help patients by taking a weekend course alone.”

DG


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Reading of the Week: Smoking Cessation – Doing Bad, Feeling Good? Also, Ethnicity & Opioids (JAMA Psych) and Dr. Freedman on Lunches (Acad Psych)

December 1, 2022 /

From the Editor

We ask our patients about cannabis. We inquire about illicit drugs. But are we forgetting tobacco? A new paper in Psychiatric Services helps answer that question – and, perhaps, raises other questions, including about how we could do better. 

In the first selection, Sarah A. White (of Johns Hopkins University) and her co-authors draw on American data to look at smoking cessation medications in a new Psychiatric Services paper. Among more than 55,000 smokers (many of whom have mental illness), they find that: “Cessation pharmacotherapy for smokers remained vastly underprescribed across all groups. At least 83% of smokers with or without mental illness did not receive varenicline, NRT, or bupropion during the 14-year study period.” We consider the paper and its clinical implications.

In the second selection, Huiru Dong (of Harvard University) and her co-authors look at buprenorphine treatment and demographics in the United States. Their JAMA Psychiatry research letter, which was just published, finds a growing gap. “The observed heterogeneity in buprenorphine treatment duration among racial and ethnic groups may reflect disproportionate structural barriers in treatment retention for Opioid Use Disorder.”

In the third selection, Dr. David Freedman (of the University of Toronto) writes about resident lunches for Academic Psychiatry. Dr. Freedman, who is a resident, notes that in-person lunches shifted to virtual ones for more than two years because of the pandemic – something that was necessary but unfortunate. He argues that the gatherings are important. “Yet, as a collective of residents munch on the last bites of their sandwiches, say goodbye, and return to work, I am struck by the camaraderie. Funded resident lunches nurture the professional identities of psychiatry trainees – an essential element of medical education.”

DG

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Reading of the Week: Health Care Workers’ Mental Health – There’s an App for That; Also, Treating Opioids (BMJ) & Dr. Bhushan on Her Bipolar (LA Times)

September 15, 2022 /

From the Editor

With the pandemic dragging on, health care workers report more and more burnout; some complain of depression and anxiety.

What could help? Dr. Sam N. Gnanapragasam (of King’s College London) and his co-authors consider an app designed to provide CBT and mindfulness techniques in a new British Journal of Psychiatry paper. The RCT study involves 16 English sites with over 1000 health care workers. They conclude: “our study suggests that the app was of modest benefit with no adverse effects for a sample of HCWs in England.” We look at the paper.

How to respond to the opioid crisis? In a new analysis paper for BMJ, Dr. Robert A. Kleinman (of the University of Toronto) and his colleagues argue for a different approach to the prescribing of opioid agonist therapy, drawing on the changes made in response to the pandemic. “Embracing a more flexible model of buprenorphine-naloxone dosing would allow better alignment of prescribing practices with the needs and preferences of clients.”

And in the third selection, Dr. Devika Bhushan writes about bipolar disorder for the Los Angeles Times. The essay is very personal: the pediatrician, who serves as California’s acting surgeon general and graduated from Harvard, describes her own experiences. As she notes, during her training, she “had a secret.” Now, however, she speaks openly about her illness. “Today, I live with bipolar disorder as a chronic and manageable health condition.” 

DG

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Reading of the Week: Buprenorphine for Opioids – the New AJP Paper; Also, Cannabis & Hospitalizations (CJP) and Dr. Rosenberg’s Career & Illness (NYT)

August 11, 2022 /

From the Editor

A rise in substance use. Staff shortages and burnout. Waits for care.

The problems of the pandemic on mental health care have been clear and unfortunate. But how has care changed – and possibly improved – over the pandemic? In the first selection, Lewei Lin (of the University of Michigan) and her co-authors look at buprenorphine treatment before and during the pandemic. In a new paper for The American Journal of Psychiatry, they find a shift in care and a success story: “The number of patients receiving buprenorphine continued to increase after the COVID-19 policy changes, but the delivery of care shifted to telehealth visits…” We consider the paper and its clinical implications.

In the second selection, drawing on Canadian data, Chungah Kim (of Brock University) and her co-authors look at cannabis legalization and cannabis-related hospitalizations. In this new Canadian Journal of Psychiatry brief report, they find: “the initial legalization was followed by clinically significant increases in cannabis-related hospitalizations; however, the subsequent increase in retail stores, availability of cannabis edibles, and COVID-19 pandemic was not associated with a further increase in hospitalizations in Ontario.”

In the third selection, we consider the life and legacy of Dr. Leon E. Rosenberg with the obituary from The New York Times. Dr. Rosenberg had a storied career – a pioneer in genetics research, a dean of Yale, and the chief science officer at Bristol Myers Squibb. He’s also a person who had bipolar disorder and took lithium. “I am proof that it is possible to live a highly successful career in medicine and science, and to struggle with a complex, serious mental illness at the same time.”

Please note that there will be no Readings for the next two weeks.

DG


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Reading of the Week: Way Up – Alcohol-Related Deaths During the Pandemic (JAMA); Also, Addressing the Opioid Crisis (CJP) and the NYT on Grief

March 31, 2022 /

From the Editor

Three patients have recently told their stories to me. With his business failing, he turned to alcohol. When she couldn’t get hours at the restaurant because of the lockdown, she started drinking in the mornings. After a decade of sobriety, he explained that he found comfort in alcohol after his job loss.

These stories aren’t, unfortunately, surprising. With the pandemic, substance use appears to be on the rise. But what about substance-related deaths? In the first selection, we look at a new research letter from JAMA. Aaron M. White (of the National Institute on Alcohol Abuse and Alcoholism) and his co-authors examine alcohol-related deaths in the United States and the impact of the pandemic. They conclude: “The number and rate of alcohol-related deaths increased approximately 25% between 2019 and 2020, the first year of the COVID-19 pandemic.” We consider the paper and its clinical implications.

In the second selection, Dr. Tony P. George (of the University of Toronto) and his co-authors focus on the opioid crisis. In this Canadian Journal of Psychiatry commentary, they argue for a stronger approach to help those with opioid use disorder (OUD), specifically by improving the psychosocial interventions available. “While psychosocial interventions are often expensive and time consuming, they do make a difference in the lives of patients with OUD and those at risk for fatal opioid overdoses, especially when combined with broad psychosocial supports that address social determinants of health.”

And in the third selection, continuing our consideration of the first update to the DSM series in nine years, we look at a New York Times article, just published. Reporter Ellen Barry writes about prolonged grief disorder: “The new diagnosis was designed to apply to a narrow slice of the population who are incapacitated, pining and ruminating a year after a loss, and unable to return to previous activities.”

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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