Tag: opioid

Reading of the Week: Substance – with New Papers from JAMA Psych, Netw Open & Brookings; Also, the Latest in the News

February 20, 2025 /

From the Editor

For many of our patients, the pull of alcohol can be strong with devastating effects. In recent months, semaglutide, better known for its weight-loss properties, has generated some buzz. Could semaglutide help those with alcohol problems?

In the first selection, Christian S. Hendershot (of the University of Southern California) and his co-authors attempt to answer that question in a new paper for JAMA Psychiatry. They conducted an RCT with 48 participants randomized to semaglutide or placebo over nine weeks, measuring alcohol consumption and craving outcomes, and finding that people taking semaglutide consumed less alcohol by some measures. “These findings provide initial prospective evidence that low-dose semaglutide can reduce craving and some drinking outcomes, justifying larger clinical trials to evaluate GLP-1RAs for alcohol use disorder.” We consider the paper and its implications.

In the second selection, Joshua L. Gowin (of the University of Colorado) and his co-authors explore the impact of heavy lifetime and recent cannabis use on brain function in a new paper for JAMA Network Open. They analyzed data from more than 1 000 young adults, including brain imaging, focusing on tasks administered during fMRIs sessions. “Cannabis use is associated with short- and long-term brain function outcomes, especially during working memory tasks.”

Finally, we explore the latest news with articles from The New York Times and The Free Press, and a new report from the Brookings Institution. The topics: Oregon’s decriminalization, Robert F. Kennedy’s nomination, and decriminalization across North America.

DG

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Reading of the Week: Alcohol Use Disorder – The NEJM Review; Also, Private Equity & Opioid Treatment and Gee on Refusing Help

January 30, 2025 /

From the Editor

When she was admitted for liver cirrhosis – the last hospitalization in her too-short life – no one visited. In her community, the stigma was great. As she grew more and more ill, I asked if she wanted me to call her family to be at the bedside. She simply smiled and said that they were all busy.

Over the years, I have seen many patients like this woman; we all have. Alcohol misuse is common. What’s the best evidence for screening and treatment? Dr. Paul S. Haber (of the University of Sydney) tries to answer that question with a sparkling review, published in The New England Journal of Medicine. His paper is clearly written and draws from more than sixty references. “Alcohol use disorder is a relapsing and remitting medical and psychological disorder that influences physical health, mental health, and social functioning, and continuing care is recommended.” We consider the review and several key take-aways.

In the second selection, David T. Zhu (of Virginia Commonwealth University) and his co-authors analyze the ownership of opioid treatment programs in the United States, with a particular focus on private equity. The research letter, published in JAMA Psychiatry, drew on government data. “This study found that 29.1% of US opioid treatment programs were owned by private equity firms, exceeding private equity penetration in other sectors of health care (range, 2%-11%).”

And in the third selection, columnist Marcus Gee of The Globe and Mail writes about mental illness and patient rights. He discusses a woman in his neighbourhood who has delusions and refuses shelter in the cold weather, convinced that she will soon be offered keys to a new home. “Surely she deserves better. Surely we can do better.”

DG


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Reading of the Week: In-person vs. Remote CBT – the New CMAJ Study; Also, Treatment & Opioids in the US, and AI & Med School Exams

July 25, 2024 /

From the Editor

In the early days of the pandemic, patients connected with us virtually from their kitchens and bedrooms – and, yes, their closets and washrooms. But as COVID-19 fades, we may wonder: what care should be delivered virtually and what should be done in person?

In the first selection, Sara Zandieh (of McMaster University) and her co-authors examine remote versus in-person CBT in a new CMAJ study. They conducted a systematic review and meta-analysis with 54 randomized controlled trials and almost 5 500 participants, addressing both physical and mental problems. “Moderate-certainty evidence showed little to no difference in the effectiveness of in-person and therapist-guided remote CBT across a range of mental health and somatic disorders, suggesting potential for the use of therapist-guided remote CBT to facilitate greater access to evidence-based care.” We consider the paper and its implications.

In the second selection, Dr. Tae Woo Park (of the University of Pittsburgh) and his co-authors explore opioid use disorder (OUD) treatment. In their JAMA research letter, they compared medication and psychosocial treatments for OUD across the United States, surveying more than 17 000 facilities and analyzing the availability of evidenced-based interventions like buprenorphine and contingency management. “Substance use treatment facilities reported significant gaps in provision of effective treatments for OUD.”

And in the third selection from CNBC, Dr. Scott Gottlieb and Shani Benezra (both of the American Enterprise Institute) describe their experiment: they tasked several large language models with answering questions from the USMLE Step 3. The average resident score is 75%; four of five AI programs surpassed that benchmark. “[These models] may offer a level of precision and consistency that human providers, constrained by fatigue and error, might sometimes struggle to match, and open the way to a future where treatment portals can be powered by machines, rather than doctors.”

There will be no Reading next week.

DG

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Reading of the Week: Psychological Interventions for Schizophrenia – the New Lancet Psych Study; Also, Service Dogs for PTSD, and the Latest in the News

July 4, 2024 /

From the Editor

She was distressed by the voices and the paranoid thoughts. Many nights, my patient could barely sleep. She had tried several medications without much improvement. Is there a role for psychological interventions? Would CBT help? What is the evidence for this population?

In the first selection, Nurul Husna Salahuddin (of the Technical University of Munich) and co-authors attempt to answer these questions in a new systematic review and network meta-analysis, just published in Lancet Psychiatry. The analyzed 52 RCTs with 5 034 participants. “We provide robust findings that CBTp can reduce the overall symptoms of patients with treatment-resistant schizophrenia, and therefore clinicians can prioritise this intervention in their clinical practice.” We consider the paper and its clinical implications.

In the second selection from JAMA Network Open, Sarah C. Leighton (of the University of Arizona) and her co-authors describe a study involving service dogs for those with PTSD. In a nonrandomized controlled trial involving 156 military members and veterans, they examined outcomes after three months. “[C]ompared with usual care alone, partnership with a trained psychiatric service dog was associated with lower PTSD symptom severity and higher psychosocial functioning in veterans.”

Finally, we explore the latest news with recent articles from The Guardian, the Ottawa Citizen, and The New York Times. Among the topics: “honest” obituaries and the opioid crisis, antidepressants and withdrawal, and care for pregnant women with substance problems.

DG

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Reading of the Week: Visual Hallucinations & Outcomes – the New Schizophrenia Study; Also, Opioid Deaths in Canada and Dr. Roy Perlis on Antidepressants

April 25, 2024 /

From the Editor

Last week, I met a person who had deeply unsettling auditory hallucinations. I asked him the questions that we all ask: When did the voices start? How many voices do you hear? Do the voices tell you to do things? In contrast, while we know that people with psychotic illnesses can have visual hallucinations, we rarely inquire about them and if we do, it’s in a perfunctory manner, as I did with him. Clinicians aren’t the only ones to gloss over visual hallucinations; they tend to be under-researched, especially with regard to long-term outcomes.

In the first selection, Isabel Kreis (of the University of Oslo) and her co-authors look at outcomes and visual hallucinations in an impressive, new study published in Schizophrenia. They report on 184 people from Norway with first-episode psychosis, followed for ten years, with a focus on visual hallucinations and functionality, suicide attempts, and childhood trauma. “These findings highlight the relevance of assessing visual hallucinations and monitoring their development over time.” We consider the paper and its implications.

In the second selection from CMAJ, Shaleesa Ledlie (of the University of Toronto) and her co-authors report on opioid-related deaths in Canada. They drew from a national database and looked at several years of data, including over the start of the pandemic. “Across Canada, the burden of premature opioid-related deaths doubled between 2019 and 2021, representing more than one-quarter of deaths among younger adults.”

And in the third selection, Dr. Roy Perlis (of Harvard University) argues that the time has come for over-the-counter antidepressants in a STAT essay. He notes that many people with depression are untreated and that increasing the availability of these medications would be helpful. “With part of the solution hiding in plain sight, it’s time to do everything possible to give Americans another way to get treatment.”

DG

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Reading of the Week: Self-stigma & Depression – the new JAD Study; Also, ChatGPT & Mental Health Care, and Dr. Catherine Hickey on the Opioid Crisis

November 2, 2023 /

From the Editor 

Depression is the result of character weakness. So explained my patient who had a major depressive disorder and hesitated to take medications.

Though fading, stigma about mental illness continues to exist, including self-stigma, the negative thoughts and beliefs that patients have about their own disease – as with my patient. How common is self-stigma? How does its prevalence differ around the globe? What are risk factors for it? Nan Du (of the University of Hong Kong) and co-authors attempt to answer these questions in a new Journal of Affective Disorders paper. They do a systematic review and meta-analysis of self-stigma for people with depression, drawing on 56 studies with almost 12 000 participants, and they a focus on international comparisons. “The results showed that the global prevalence of depression self-stigma was 29%. Levels of self-stigma varied across regions, but this difference was not significant.” We consider the paper and its clinical implications.

In this week’s second selection, we look at ChatGPT and mental health care. Dr. John Torous (of Harvard University) joins me for a Quick Takes podcast interview. He sees potential for patients – including making clinical notes more accessible by bridging language and knowledge divides – and for physicians, who may benefit from a more holistic differential diagnosis and treatment plan based on multiple data sets. He acknowledges problems with privacy, accuracy, and ChatGPT’s tendency to “hallucinate,” a term he dislikes. “We want to really be cautious because these are complex pieces of software.” 

And in the third selection, Dr. Catherine Hickey (of Memorial University) writes about the opioid crisis for Academic Psychiatry. The paper opens personally, with Dr. Hickey describing paramedics trying to help a young man who had overdosed. She considers the role of psychiatry and contemplates societal biases. “[I]n a better world, the needless deaths of countless young people would never be tolerated, regardless of their skin color.”

DG

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Reading of the Week: Substances, Substances, Substances – Papers from CJP & JMIR, and Dr. Devine on Our Federal Strategy

August 3, 2023 /

From the Editor

Creams, gummies, drinks. Cannabidiol (CBD) is increasingly popular and found in various products. Given its supposed benefits, including as an anxiolytic, could CBD be part of a harm reduction strategy?

In new paper for The Canadian Journal of Psychiatry, Lindsay A. Lo (of the University of Toronto) and her co-authors attempt to answer that question with a rapid review of 27 studies, including 5 randomized trials, covering opioids, cocaine, and polydrug use. “Low-quality evidence suggests that CBD may reduce drug cravings and other addiction-related symptoms and that CBD may have utility as an adjunct harm reduction strategy for people who use drugs.” We discuss the paper and its implications.

In the second selection, Dr. Braden O’Neill (of the University of Toronto) and his co-authors consider cannabis clinic websites. Focusing on Ontario, they find 29 clinic websites. In new paper for Journal of Medical Internet Research, they look at the claims made, and analyze the supporting literature. “The recommendation of cannabis as a general therapeutic for many indications unsupported by high-quality evidence is potentially misleading for medical practitioners and patients.”

And in the third selection, Dr. Jeremy Devine (of McMaster University) writes about federal drug policy in an essay for The Toronto Star. He feels that the current approach to the opioid crisis is flawed, with its focus on “regulation” – and he is particularly critical of safe supply programs. “The core ideological flaw in our drug policy is that it fails to recognize a hard truth: the drug user cannot have both their addiction and a free, safe, and self-determined life.”

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: rTMS – the New JAMA Psych Paper; Also, Opioid Overdoses (JAMA Net Open) and Green on Peak Mental Health (NYT)

October 13, 2022 /

From the Editor

She’s an accomplished person who had succeeded in business and then writing, all the while raising three children; she also has an amazing smile and lights up the room when talking about her kids. But in my office, sick with depression, she can only focus on her losses and failings; the smile is absent.

Depression is common and disabling. Those who are affected in late-life are particularly challenging to treat. Is there a better way? In the first selection from JAMA Psychiatry, Dr. Daniel Blumberger (of the University of Toronto) and his co-authors consider theta burst stimulation, a newer form of rTMS which has shown promise in earlier work. Their study is a randomized noninferiority trial, directly comparing the two versions of rTMS in elderly patients with depression. The result? “We showed that bilateral TBS was noninferior to standard bilateral rTMS in improving depression, and similarly well tolerated, in a real-world sample of older adults with TRD [treatment resistant depression]…” We review the paper and its clinical implications.

In the second selection, Lori Ann Post (of Northwestern University) and her co-authors draw on CDC data to look at opioid overdoses in the United States with a focus on geography. In a JAMA Network Open research letter, they find: “Overall, opioid-involved overdose deaths rates increased steadily in counties of every urbanicity type, although there were distinct temporal wave patterns by urbanicity.”

And in the third selection, Huw Green (of the University of Cambridge) wonders about mental health and mental illness – and worries that the terms are becoming blurred together. Writing in The New York Times, the psychologist concludes: “When we move away from a focus on psychological problems and toward ‘mental health’ more broadly, clinicians stumble into terrain that extends beyond our expertise. We ought to be appropriately humble.”  

This month, the Reading of the Week enters its ninth year. A quick word of thanks for your ongoing interest.

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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