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Small Increase Seen in Peer Support Services After Launch of 988

The launch of the 988 Suicide and Crisis Lifeline (988) did not coincide with growth in the availability of most crisis services, apart from a small increase in peer support services, according to a study published online Jan. 29 in JAMA Psychiatry.

Jonathan Cantor, Ph.D., from RAND in Santa Monica, California, and colleagues examined whether the launch of 988 was associated with the availability of crisis services in a cohort study characterizing trends in crisis services offered by U.S. mental health treatment facilities (MHTFs). Longitudinal data were obtained from the Mental Health and Addiction Treatment Tracking Repository.

The researchers found that across 15,623 MHTFs (184,769 observations: 79,268 before and 105,501 after the launch of 988), the largest changes were observed for availability of peer support services (increase from 39 to 42 percent) and emergency psychiatric walk-in services (decrease from 32 to 29 percent) from before to after the 988 launch. After the 988 launch, the odds of peer support availability increased 1.3 percent per month and odds of emergency psychiatric walk-in service availability decreased by 0.6 percent per month when controlling for MHTF characteristics (odds ratios, 1.013 and 0.994, respectively). At the national level, there was also a decrease seen in availability of other service types, with a decrease from 22 to 21 percent in mobile crisis response and from 69 to 68 percent in suicide prevention from before to after the 988 launch.

"Public health officials and policymakers may consider policies that boost the financing and availability of such services to increase the likelihood of success for 988," the authors write.

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Medical Use of Cannabis Tied to Higher Prevalence of Cannabis Use Disorder

Adults aged 18 to 49 years reporting medical-only or medical-nonmedical cannabis use may have a higher prevalence of cannabis use disorder (CUD) than those reporting nonmedical only, according to a research letter published online Jan. 22 in JAMA Psychiatry.

Beth Han, M.D., Ph.D., M.P.H., from the National Institutes of Health in Bethesda, Maryland, and colleagues examined differences in cannabis use frequency and CUD prevalence for medical-only and medical-nonmedical versus nonmedical-only use among U.S. adults aged 18 to 49 years. The analysis included data from 72,668 participants in the 2021 to 2022 National Surveys on Drug Use and Health.

The researchers found that 29.5 percent of respondents reported past-year cannabis use: 83.7 percent for nonmedical-only use, 9.2 percent medical-only use, and 5.7 percent for medical-nonmedical use. More than one-third (34.8 percent) had CUD. A higher adjusted prevalence of severe, moderate, and mild CUD was seen among men and women aged 18 to 34 years and men aged 35 to 49 years reporting medical-only or medical-nonmedical use versus those reporting nonmedical-only use. Adults reporting medical-only or medical-nonmedical use had more days of cannabis use than those reporting nonmedical-only use.

"Clinicians should consider addiction risk before recommending medical cannabis and, if they do, should monitor for CUD emergence," the authors write.

One author disclosed having long-term stocks with relevant companies.

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Was the FDA Too Quick Approving Test for Opioid Addiction Risk?

FRIDAY, April 5, 2024 (HealthDay News) -- A test to gauge if it's safe to prescribe a patient an addictive opioid may have been approved too soon by the U.S. Food and Drug Administration, claims a letter sent to the agency by a group of experts.

The test, called AvertD, is meant to screen for genetic markers suggesting that a person has a higher likelihood of developing an opioid use disorder (OUD). If the test result is positive, doctors could try alternative medications.

However, the FDA approved the test in December against the advice of its own advisory panel, the experts noted in their letter. They claim that AvertD is inaccurate and could actually lead to more opioid dependencies, not fewer.

“This test will make the opioid crisis worse,” said Dr. Andrew Kolodny, medical director of opioid policy research at Brandeis University in Massachusetts and one of the authors of the letter.

“It will contribute to overprescribing, it will contribute to an increased incidence of opioid use disorder," he told NBC News. "In other words, more people becoming newly addicted to opioids.”

He and the letter co-authors asked FDA Commissioner Robert Califf to revoke the agency's approval.

Neither the FDA nor the test's maker, California-based SOLVD Health, responded to NBC News for comment.

According to data from the Substance Abuse and Mental Health Services Administration, over 6.1 million Americans were reported to have an opioid use disorder in 2022, and opioids have contributed to over 645,000 deaths over the past 20 years.

Opioid prescriptions given after surgery or to relieve pain are a prime "gateway" to addiction for many. In theory, knowing in advance if a person had a genetic vulnerability to opioid use disorder could reduce new cases of addiction.

AdvertD promised to do just that. But the FDA's own panel of experts overwhelmingly ruled against approval, citing doubts about the test's ability to accurately spot patients at addiction risk.

That could mean that doctors are lulled into a false sense of security and prescribe an opioid to a person who is, indeed, at risk for addiction.

Or, if the person is not at high risk for opioid addiction but the test comes out positive, they may be stigmatized as a potential addict and miss out on painkillers that could help them, Kolodny and colleagues added.

In their letter, they called the test useless, saying it cannot predict the odds for addiction "any better than chance."

When the FDA approved AvertD in December, it stressed that the test only be used and interpreted by well-trained staff, and it "should be used as part of a complete clinical evaluation and risk assessment; it should not be used alone to make treatment decisions."

AvertD is not to be used in decision-making for people suffering from chronic pain, the agency said.

"Given the totality of available evidence and the urgent need for medical devices that can make a positive impact on the overdose crisis, and specifically devices that can help assess the risk of developing OUD, the FDA determined that there is a reasonable assurance of AvertD's safety and effectiveness, taking into consideration available alternatives, patients' perspectives, the public health need and the ability to address uncertainty through the collection of post-market data," the agency said.

But Dr. Katherine Keyes, a professor of epidemiology at the Columbia University Mailman School of Public Health in New York City, said any test that relies only on a few genetic markers is bound to be flawed when it comes to predicting the likelihood of addiction.

Addiction is far too "complex" for that, she told NBC News.

“We know the risk of OUD increases with the dose and duration of an opioid prescription,” Keyes said. “Receiving an opioid prescription remains one of the strongest risk factors for the development of opioid use disorder.”

In its application for FDA approval, SOLVD Health said the AvertD test had a sensitivity of about 82% and a specificity of about 79%.

That means that in roughly one in every five cases, a test would produce a false-negative result (meaning it failed to spot someone at high risk) or a false-positive result (meaning it designated the person as high-risk, even though they are not).

Given those numbers, "I think the product has the potential to do harm,” Dr. Adam Gordon, who was a member of the FDA's advisory panel, told NBC News. He's a professor of medicine and psychiatry at the University of Utah School of Medicine

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Find out more about opioid use disorder at the American Psychiatric Association.

SOURCE: NBC News, April 4, 2024

Meds Rarely Initiated After Discharge for Alcohol Use Disorder

FRIDAY, June 30, 2023 (HealthDay News) -- Patients hospitalized for alcohol use disorder (AUD) rarely initiate medications for AUD (MAUD) after discharge, according to a research letter published online June 27 in the Annals of Internal Medicine.

Eden Y. Bernstein, M.D., from Massachusetts General Hospital in Boston, and colleagues characterized MAUD treatment initiation after AUD hospitalizations using a sample of Medicare Parts A, B, and D beneficiaries with continuous enrollment 12 months before and after cohort entry. A total of 28,601 AUD hospitalizations representing 20,401 unique patients were included in the cohort.

Overall, 206 and 364 patients initiated MAUD treatment within two and 30 days of discharge, respectively (0.7 and 1.3 percent). Of patients with a primary discharge diagnosis of AUD, 2.3 percent initiated MAUD treatment within two days of discharge. The researchers found that younger age was the most predictive demographic factor for discharge initiation of MAUD treatment (adjusted odds ratio, 3.87 for age 18 to 39 versus ≥75 years). Absence of self-directed discharge, psychiatric hospital, or psychiatry or addiction medicine inpatient care versus no addiction medicine or psychiatry, and a primary discharge diagnosis of AUD were the strongest hospitalization predictors (adjusted odds ratios, 18.48, 9.80, 6.23, and 4.75, respectively). Remote MAUD use, female sex, psychiatric disorders, and lower Elixhauser index were additional predictors. Similar predictors were seen for the outcome of MAUD treatment initiation within 30 days.

"Our findings highlight missed opportunities for MAUD treatment initiation among the high-risk group of patients with AUD who are hospitalized," the authors write.

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New Poll Shows U.S. Adults Find Cigarettes Most Unsafe, Addictive Substance

TUESDAY, June 13, 2023 (HealthDay News) -- Despite knowing cigarettes are unsafe and addictive, one in five U.S. adults report smoking every day, according to the results of a survey conducted by the American Psychiatric Association.

The annual survey, which complements the association’s Healthy Minds Monthly poll, was conducted April 20 to 22, 2023, and included a sample of 2,201 adults.

According to the results of the survey, 84 percent of respondents said cigarettes are unsafe and 87 percent acknowledged they were addictive, but still 21 percent reported smoking every day. This compares to 13 percent who said they use cannabis/marijuana daily, 8 percent vaping daily, and 7 percent using alcohol daily. Four percent use prescribed opioids daily and 2 percent said they use nonprescription opioids daily. Roughly half of U.S. adults thought addictions are a result of personal weakness (47 percent), but most (93 percent) agreed that substance use disorders can be treated. Furthermore, just over three-quarters agreed that addictions are medical disorders and that they are preventable (76 percent for both). Over half of respondents (58 percent) said they have seen, read, or heard about Narcan and/or naloxone before, but only one-third (35 percent) said they would know where to find it in the case of an opioid overdose.

"We can help prevent more Americans from other potentially addictive behaviors, like drinking alcohol and technology use," Petros Levounis, M.D., the president of the American Psychiatric Association, said in a statement. "We can also make sure that people know about our current safe and effective treatments for both substance use disorders and the behavioral addictions. Addiction treatment works."

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