The epidemic within the pandemic: Behavioral health and substance use in the face of COVID-19

Addiction as a Coping Response: Hyperkatifeia, Deaths of Despair, and COVID-19.

Letter to editor

The Evidence for SBIRT in Adolescents

Poster Abstracts from the AAAP 20th Annual Meeting and Symposium

COVID-19 and Stress-Related Disorders.

Substance use disorder (SUD) among women of reproductive age is a complex public health problem affecting a diverse spectrum of women and their families, with potential consequences across generations. The goals of this study were 1) to describe and compare the prevalence of patterns of injury requiring emergency department (ED) visits among SUD-positive and SUD-negative women and 2) among SUD-positive women, to investigate the association of specific categories of injury with type of substance used. This study was a secondary analysis of a large, multisource health care utilization data set developed to analyze SUD prevalence, and health and substance abuse treatment outcomes, for women of reproductive age in Massachusetts, 2002 through 2008. Sources for this linked data set included diagnostic codes for ED, inpatient, and outpatient stay discharges; SUD facility treatment records; and vital records for women and for their neonates. Injury data (ICD-9-CM E-codes) were available for 127,227 SUD-positive women. Almost two-thirds of SUD-positive women had any type of injury, compared to 44.8% of SUD-negative women. The mean (±SD) number of events also differed (2.27 ± 4.1 for SUD-positive women vs. 0.73 ± 1.3 for SUD-negative women, p < 0.0001). For four specific injury types, the proportion injured was almost double for SUD-positive women (49.3% vs 23.4%), and the mean (±SD) number of events was more than double (0.72 ± 0.9 vs. 0.26 ± 0.5, p < 0.0001). The numbers and proportions of motor vehicle incidents and falls were significantly higher in SUD-positive women (22.5% vs. 12.5% and 26.6% vs. 11.0%, respectively), but the greatest differences were in self-inflicted injury (11.5% vs. 0.8%; mean ± SD events = 0.19 ± 0.9 vs. 0.009 ± 0.2, p < 0.0001) and purposefully inflicted injury (11.5% vs 1.9%, mean ± SD events = 0.18 ± 0.1 vs. 0.02 ± 0.2, p < 0.0001). In each of the injury categories that we examined, injury rates among SUD-positive women were lowest for alcohol disorders only and highest for alcohol and drug disorders combined. Among 33,600 women identified as using opioids, 2,132 (6.3%) presented to the ED with overdose. Multiple overdose visits were common (mean ± SD = 3.67 ± 6.70 visits). After adjustment for sociodemographic characteristics, psychiatric history, and complex/chronic illness, SUD remained a significant risk factor for all types of injury, but for the suicide/self-inflicted injury category, psychiatric history was by far the stronger predictor. The presence of SUD increases the likelihood that women in the 15- to 49-year age group will present to the ED with injury. Conversely, women with injury may be more likely to be involved in alcohol abuse or other substance use. The high rates of injury that we identified among women with SUD suggest the utility of including a brief, validated screen for substance use as part of an ED injury treatment protocol and referring injured women for assessment and/or treatment when scores indicate the likelihood of SUD.

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Substance Use Disorders Are Deadly.

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Medicolegal Issues with Reference to NDPS and MHCA in Management and Rehabilitation of Persons with Substance Use Disorders.

While there is broad recognition of the high societal costs of substance use disorders (SUD), treatment rates are low. We examined whether, in the United States, participants with substance or alcohol use disorder would report a greater willingness to enter SUD treatment located in a primary care setting (primary care) or more commonly found specialty care setting in the United States (usual care). Randomized survey-embedded experiment. US web-based research panel in which participants were randomized to read one-paragraph vignettes describing treatment in usual care (specialty drug or alcohol treatment center), primary care or collaborative care within a primary care setting. A total of 42451 panelists aged 18+ were screened for substance or alcohol use disorder using validated diagnostic criteria. Participants included 344 with a substance use disorder and 634 with an alcohol use disorder not in treatment with no prior treatment history. Willingness to enter treatment across vignettes by condition. Among participants with a substance use disorder, 24.6% of those randomized to usual care reported being willing to enter drug treatment compared with 37.2% for primary care [12.6 percentage point difference; 95% confidence interval (CI)=0.8, 24.4) and 34.0% for collaborative care (9.4 percentage point difference; 95% CI=-2.0, 20.8). Among participants with an alcohol use disorder, 17.6% of those randomized to usual care reported being willing to enter alcohol treatment compared with 20.3% for primary care (2.6 percentage point difference; 95% CI=-4.9, 10.1) and 20.8% for collaborative care (3.1 percentage point difference; 95% CI=-4.3, 10.6). The most common reason for not being willing to enter drug (63%) and alcohol (78%) treatment was the belief that treatment was not needed. In the United States, people diagnosed with substance or alcohol use disorders appear to be more willing to enter treatment in a primary care setting than in a specialty drug treatment center. Expanding availability of primary care-based substance use disorder treatment could increase treatment rates in the United States.

COVID‐19's impact on the mental health of older adults: Increase in isolation, depression, and suicide risk. An urgent call for action

Back to table of contents Previous article Next article ProfessionalFull AccessDrug Overdose Deaths Reach Grim Milestone During PandemicLinda M. RichmondLinda M. RichmondSearch for more papers by this authorPublished Online:28 Dec 2021https://doi.org/10.1176/appi.pn.2022.2.6AbstractAddiction experts say psychiatrists can help prevent overdose deaths by expanding their practices to assess for and treat substance use disorder.Drug overdoses killed more than 100,000 people in the United States during the one-year period ending April 2021, marking the first time that overdoses reached six digits in a span of 12 months, according to provisional data from the Centers for Disease Control and Prevention (CDC). The grim milestone represents a 29% increase in overdose deaths from the prior year.Synthetic opioids, primarily fentanyl and its analogs, were responsible for 64% of the total deaths for the one-year period, a rise of nearly 50%, according to the CDC’s National Center for Health Statistics. Psychostimulants with abuse potential such as methamphetamine were responsible for 28% of the total deaths, a 48% increase from the previous year.In response to the CDC data, APA released a statement renewing its call for improved access to mental health and substance use services through early identification, utilizing evidence-based models that integrate behavioral health treatment into primary care services. APA also called for policies and programs to provide effective substance use disorder (SUD) treatment for all patients, to support medical schools and residency programs in training clinicians to treat people with SUD, and to encourage the development of an addiction workforce.“As a country, we still have a lot to improve on when it comes to following the basic tenets of SUD care,” Hilary Smith Connery, M.D., Ph.D., clinical director of the Division of Alcohol, Drugs, and Addiction at McLean Hospital and assistant professor of psychiatry at Harvard Medical School, told Psychiatric News. “We were not providing sufficient quality access to SUD services when heroin was the main illicit opioid, and now that fentanyl has largely replaced it, it is even more challenging because fentanyl is more deadly and more difficult to reverse with naloxone. It is also more difficult to stabilize a fentanyl-addicted person with medication-assisted treatment than it had been with heroin.”She continued, “We know the public health basics needed to adequately address the national opioid use disorder and drug overdose crisis, but we have been slow to implement these, and during this delay, drug traffickers are finding ‘improved’ ways to profit and to avoid detection and legal consequences.”The health care community, policymakers, and the public need to address SUDs and substance use in a way that reduces stigma and isolation, Smita Das, M.D., Ph.D., M.P.H., chair of APA’s Council on Addiction Psychiatry, told Psychiatric News. Das is an addiction psychiatrist at the Dual Diagnosis Clinic and a clinical associate professor of psychiatry and behavioral sciences, both at Stanford University. “As we break down those larger barriers, it is important to recognize that a piecemeal or fragmented approach is not enough. While I applaud the incremental policy changes that are occurring at multiple levels, the problem is like a bucket with many holes—we must patch multiple holes at a time to make a true difference.”Call to PsychiatristsDas pointed out that more than half of individuals with SUD have a comorbid mental illness, and overdoses may involve substances besides opioids, such as alcohol and polysubstance use. “Substance use and SUDs are part of what psychiatrists need to address in practice, advocacy, and education. … Psychiatrists can absolutely impact this crisis.”“By asking all patients about substance use nonjudgmentally and systematically, psychiatrists not only identify [individuals] needing treatment, but we can further reduce stigma by letting our patients know that we are interested in the bigger picture of their mental health, which may include substance use. Psychiatrists are inherently skilled at integrating motivational interviewing and cognitive-behavioral treatment, which is the gold standard in psychotherapy for SUD.”Connery called on psychiatrists to include treatment of SUD in their practices and to become familiar with prescribing of the three FDA-approved medications to treat opioid use disorder (buprenorphine, methadone, and naltrexone) as well as naloxone rescue. “Psychiatrists are in an excellent position to address the mental health challenges faced by patients with SUD, including work targeted to reduce the elevated risk for premature mortality in these populations, such as prevention of overdose, drug-related motor vehicle accidents, domestic violence, and suicide,” she said.Last November, the White House Office of Drug Control Policy issued a model law states may adopt to expand access to naloxone. At present, naloxone access is largely dependent on where one lives, according to Rahul Gupta, M.D., director of National Drug Control Policy. The model law aims to be a template for state legislatures and would require health insurers to cover naloxone, encourage citizens to obtain it, protect individuals from unjust prosecution for administering it, and increase access in educational and correctional settings.Also in November, the Department of Health and Human Services released an overview of the Biden administration’s plan to combat drug overdoses. It includes measures designed to remove barriers to prescribing medication for opioid use disorder; reduce stigma; and provide new funding for prevention, evidence-based treatment and recovery support, and harm reduction. ■APA’s statement on the CDC report on overdose deaths is posted here.The CDC data are posted here. ISSUES NewArchived

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