Category: From Newswise – Addiction

Newswise — Your brain is definitely a part of your body.

So why do tens of millions of Americans find it so hard to get help for brain-based problems, from depression and anxiety to addiction and eating disorders? 

Currently, the nation doesn’t have enough mental health care specialists to meet the rising need for this care, a fact that President Joe Biden highlighted in a recent speech at the White House.

But even if you find someone to guide your treatment, or that of your child, and get an appointment, you may find that your health insurance won’t cover the cost of your visits or the treatments that your specialist recommends.

Or you might start by calling clinics on your insurance company’s approved in-network list, and run into long waiting times or discover they aren’t in-network after all.

Or you may decide to book an appointment with a mental health provider who doesn’t take your insurance, or doesn’t take insurance at all.

That can mean spending hundreds or thousands of dollars out of pocket, perhaps with a chance of getting some of that money back if they press their insurance company for reimbursement. 

Meanwhile, getting help for a longterm physical issue like asthma, heart disease or diabetes doesn’t usually come with nearly as many barriers.

This inequality – what experts call a lack of parity – has led many children, teens and adults to go without specialized care or ongoing therapy for mental health conditions. 

That can impact every part of your life, from work and school to relationships and finances. It can also mean people won’t seek help until they have a mental health crisis, even a suicide attempt or overdose.

And that can send them to places like the Michigan Medicine psychiatric emergency department directed by Victor Hong, M.D.

This rising demand for such emergency care, and inpatient care, feeds long waits nationwide, and fueled 5 million inquiries to the 988 phone and text mental health and addiciton crisis help line last year.

“For many years, clinicians, hospital systems and most importantly, patients, have suffered the consequences of continued lack of mental health parity, despite there technically being a law enforcing this issue,” he said.

Parity laws and new proposals

That mental health parity law he’s referring to is now 15 years old, though some of its strongest provisions only took effect a few years ago. That 2008 law tried to go further than the 1996 law that preceded it, though it doesn’t apply to Medicare or Medicaid, which cover tens of millions of Americans.

All the while, mental health needs have risen steadily, accelerated recently by the stress of the pandemic and 2020 economic downturn.

That’s why the Biden administration has unveiled a new set of proposed federal rules to require insurance companies to follow the letter and spirit of those earlier laws. The public now has a chance to comment on them before they take effect.

“Numerous studies have demonstrated that even modest levels of out-of-pocket cost are associated with lower use of clinically necessary, high-value mental health services and treatments,” said A. Mark Fendrick, M.D., who directs the Center for Value Based Insurance Design and is a professor of internal medicine at the Medical School.

“This can lead to downstream consequences including worsening of illness and increased need for acute care and hospitalization. Parity in insurance coverage can address the need to balance appropriate access to essential mental health services with growing fiscal pressures faced by public and private payers.”

Any new provisions, he adds, need to have enough enforcement “teeth” in them to change the landscape.

More providers needed

But the new rules won’t affect two other key parts of this problem: A national shortage of mental health care providers, and uneven distribution of the psychiatrists, psychologists, psychiatric nurse practitioners, clinical social workers and other licensed therapists our nation does have.

Srijan Sen, M.D., Ph.D.,, director of the University of Michigan Eisenberg Family Depression Center and the Frances and Kenneth Eisenberg Professor of Depression and Neurosciences at the U-M Medical School, said “I think the specific proposed changes are worthwhile, most notably reducing prior authorizations and gathering data. But I do think the impact of these changes will be limited without concurrent changes to expand the capacity of our mental health care system and changes to reduce the number of people who develop mental health challenges in the first place.”

States like Michigan have tried to spur more people to enter mental health-related professions or practice in shortage areas by promising student loan forgiveness, while other federal proposals have been put forth or put into place.

Experts say higher pay and better benefits for mental health professionals of all kinds will be critical to encouraging more people to pursue these professions, as well as a clearer career ladder for advancement.

Another key area of promise: training people who have handled a mental health illness of their own, or in their child, to work as ‘peer providers.’

But training any type of behavioral health provider takes time, as described last fall in a report from a national medical school group.

Shrinking distance through telehealth

One silver lining in the situation: the fact that a lot of mental health care and addiction treatment can be provided over a video link or even a phone connection.

In fact, pandemic-era rules from insurers and the federal government have made telehealth mental health appointments easier to take part in for many more people. Not having to drive long distances, or take as much time off from school, work or family obligations removes barriers.

But will that virtual care option continue after 2023 or 2024 when current special rules expire?

That’s on the mind of Chad Ellimoottil, M.D., M.Sc. He’s the medical director of virtual care for Michigan Medicine, and lead author of a report on telehealth in Michigan commissioned by the Michigan Health Endowment Fund and the Flinn Foundation:

“Our recent report on telehealth use in Michigan showed that half of all Michigan counties have less than 10 mental health specialists, and 1 in 5 Michigan counties have one or no such providers,” he said.

“In the 38 counties with the most dire shortages, 57% of all visits with such providers take place via telehealth for patients with traditional Medicare, and 47% of all mental health visits were with providers in other counties. These data show that telehealth meant greater access to mental health care for people living in areas that lack providers of such care.”

Supporting primary care

Another key factor in addressing mental health needs is improving the care that people can get from their regular primary care health providers – doctors and nurses in family medicine, general pediatrics, general internal medicine and women’s health clinics.

“The vast majority of mental health care in the U.S. is provided by general practitioners, who often lack training in psychosocial interventions that are an important part of living well with mental health conditions,” explained Briana Mezuk, Ph.D., director of the Center for Social Epidemiology and Population Health at the U-M School of Public Health.

“While we have evidence-based strategies that use a patient-centered approach to address both mental and physical health in the primary care setting through a coordinated team of nurses, physicians and other professionals, these strategies need to be made more widely available.”

Outreach programs from psychiatry departments like Michigan Medicine’s offer these primary care providers a “lifeline” for specialized support in caring for patients with specialized needs, as well as training.

Joanna Quigley, M.D. helps run Michigan’s program, called MC3. She’s the associate medical director for child and adolescent outpatient psychiatry and addiction treatment at Michigan Medicine.

“Moving toward true parity for mental and behavioral health care continues to be elusive for many, and we need and welcome interventions that remove barriers during a time of unprecedented demand for mental health care,” she said.

Another U-M-led study showed success in supporting rural primary care providers in caring for complex issues in adults.

More research needed

While the race to increase clinical access and remove barriers accelerates, researchers at universities and think tanks continue to study the issue and quantify how big the problem is and what impact policy changes are having.

Kyle Grazier, DrPH, is one of them.

As the Richard Carl Jelinek Professor of Health Services Management and Policy and a professor of psychiatry, she conducts research on payment models and their incentives to create and sustain access to high quality mental health services that are delivered through integrating primary care with community systems.

Grazier sees progress and reason for optimism in this latest federal proposal, and others in recent years.

But she also knows the improvements meant to repair the current system of mental health care and insurance will take time.

“For the consumer, the out-of-pocket cost for therapy or medication management can be prohibitive, and much more expensive than equivalently complex or time-consuming medical procedures, even if a provider is in an insurer’s network. The stark imbalance between needing care and receiving care has led to a call to respond to the behavioral health crisis.”

But even as research continues, experts like Nasuh Malas, M.D., the director of child and adolescent psychiatry at Michigan Medicine, welcomes the new federal proposal as a key step toward a larger goal.

He said, “I believe this is a good step to seeing mental health and substance use care and treatment as an important component of overall health, and as critical as physical health to the well-being of our patients.”

Newswise — Opioids remain the most potent and effective pain relievers in medicine, but they’re also among the most addictive drugs that can halt a person’s ability to breathe during an overdose — which can be deadly. Researchers have been racing to develop safer pain reliever drugs that target a specific opioid receptor, called the kappa opioid receptor, that is only found in the central nervous system and not elsewhere in the body, like other opioid receptors. Previous research suggests that such drugs may not lead to addiction or death due to overdose, but the currently known drugs that target these kappa opioid receptors have their own set of unacceptable side effects, including depression and psychosis.

In one of the first steps towards eventually developing a new wave of kappa opioid receptor drugs without these side effects, researchers at the University of Maryland School of Medicine and Washington University have mapped the 3D structure of the central nervous system specific kappa opioid receptor and figured out how it differs from the other opioid receptors. In this new study, they discovered what instructs the kappa opioid receptor to change its shape, which uniquely binds to opioid drugs, akin to a lock fitting with a specific key.  

They published their results in the May issue of Nature.

Aside from relieving pain, opioid receptors are also involved in everything from sensing taste and smell to digestion and breathing, as well as responding to many of the body’s hormones. The way that opioid receptors can influence so many functions around the body is by acting with one of seven cell activity proteins, known as G-alpha proteins, that each help to specialize the function they suppress in the cell.

“Knowing how these drugs interact with opioid receptors and having a clear view of this molecular snapshot is critical for allowing researchers to develop more effective pain-relieving drugs. This requires a drug that binds to the right type of opioid receptor, such as one in the central nervous system to reduce pain versus the ones that interact in the gut, causing side effects like constipation,” said study corresponding author Jonathan Fay, PhD, Assistant Professor of Biochemistry and Molecular Biology at UMSOM. “Additionally, these next generation medications will need to be designed with the appropriate kind of G-alpha protein in mind, as this will help to precisely target location and cell function by determining the specific shape of the opioid receptor — so the drug only reduces pain without affecting other body functions.”

The known kappa opioid receptor drugs do not produce the same euphoria as traditional opioid drugs, making these kappa opioid receptor drugs less likely to be addictive.

For the current study, the researchers used cryogenic electron microscopy in order to visualize the structure of the kappa opioid receptor. They first needed to flash freeze the receptors, which were bound to a hallucinogenic drug with one of two of the traditional G-alpha proteins. They then used a different drug to see how the kappa opioid receptor interacted with two other types of G-alpha proteins; one of these G-alpha proteins is found only in the central nervous system and the other is used to detect taste and smell.

Dr. Fay described the G-protein as shaped like a chainsaw with a handle and a ripcord. Each G-protein had a slightly different position of its chainsaw handle when bound to the kappa opioid receptor. This change in position played an active role in determining the shape of the kappa opioid receptor and thus what drug bound the best to it. These findings ultimately could have implications for how new drugs will be designed.

UMSOM Dean Mark T. Gladwin, MD, Vice President for Medical Affairs, University of Maryland, Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor, said, “Researchers face an enormous challenge in developing safer pain-reliever drugs since they will need to target both the correct opioid receptor as well as the appropriate G-alpha protein. Studies like these reinforce the mission of our new Kahlert Institute for Addiction Medicine, which aims to help develop this next generation of engineered small molecule drugs that are less addictive.

The research was supported by National Institutes of Health grants from the National Institute of General Medical Sciences (R35GM143061) and the National Institute of Neurological Disorders and Stroke (R01NS099341). The Titan X Pascal graphics card used for this research was donated by NVIDIA.

About the University of Maryland School of Medicine

Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world — with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.3 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic, and clinically based care for nearly 2 million patients each year. The School of Medicine has nearly $600 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The combined School of Medicine and Medical System (“University of Maryland Medicine”) has an annual budget of over $6 billion and an economic impact of nearly $20 billion on the state and local community. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2021, the UM School of Medicine is ranked #9 among the 92 public medical schools in the U.S., and in the top 15 percent (#27) of all 192 public and private U.S. medical schools. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu

Newswise — More than 10 million Americans misused prescription opioids in 2019, and nearly 75 percent of drug overdose deaths in 2020 involved an opioid. According to the United States Centers for Disease Control and Prevention, overdose deaths involving opioids, including prescription opioids, heroin and synthetic opioids such as fentanyl, have increased eightfold since 1999.

As scientists and the health care community search for effective ways to mitigate the opioid epidemic, rapid advances in machine learning are promising. Access to data and machine learning frameworks has led to the development of machine learning models that use health care data to deal with different facets of the opioid crisis. For example, health care databases can assist researchers and clinicians to identify patients at risk by leveraging various data and information.

But are these machine learning models built on health care data reliable at predicting opioid use disorder? That’s what researchers from Florida Atlantic University’s College of Engineering and Computer Science wanted to explore. As such, they examined peer-reviewed journal papers and conducted the first systematic review analyzing not only the technical aspects of machine learning applied to predicting opioid use, but also the published results.

Their goal was to determine if these machine learning methods are useful and, more importantly, reproducible. For the study, they reviewed 16 peer-reviewed journal papers that used machine learning models to predict opioid use disorder and investigated how the papers trained and evaluated these models.

Findings, published in the journal Computer Methods and Programs in Biomedicine, reveal that while results from the reviewed papers show machine learning models applied to opioid use disorder prediction may be useful, there are important ways to improve transparency and reproducibility of these models, which will ultimately enhance their use for research.

For the systematic review, researchers searched Google Scholar, Semantic Scholar, PubMed, IEEE Xplore and Science.gov. They extracted data that included the study’s goal, dataset used, cohort selected, types of machine learning models created, model evaluation metrics, and the details of the machine learning tools and techniques used to create the models.

Findings showed that of these 16 papers, three created their dataset, five used a publicly available dataset and the remaining eight used a private dataset. Cohort size ranged from the low hundreds to more than half a million. Six papers used one type of machine learning model, and the remaining 10 used up to five different machine learning models. Most papers did not sufficiently describe the machine learning techniques and tools used to produce their results. Only three papers published their source code.

“The reproducibility of papers using machine learning for health care applications can be improved upon,” said Oge Marques, Ph.D., co-author and a professor in FAU’s Department of Electrical Engineering and Computer Science. “For example, even though health care datasets can be hindered by privacy laws and ethical considerations, researchers should follow machine learning best practices. Ideally, the code should be publicly available.” 

The researchers’ recommendations are threefold: use the area under the precision/recall curve (AUPRC), a metric more useful in cases of imbalanced datasets when the negative class is more prevalent and there is low value in true-negative predictions; and avoid non-interpretable models (also known as “black-box models”) in this critical health care area, and favor using interpretable models whenever possible. If that is not possible and a non-interpretable model must be deployed to predict opioid use disorder, they recommend defining the reasons that justify its use. Finally, to ensure transparency and reproducibility of results, the researchers recommend the adoption of checklists and other documentation practices before submitting machine-learning-based studies for review and publication. Better documented and publicly available studies will help the research community advance the field.  

The researchers note that the lack of good machine learning reproducibility practices in the papers makes it impossible to verify their claims. For example, the evidence presented may fall short of the accepted standard, or the claim only holds in a narrower set of circumstances than asserted.

“Journal papers would be more valuable to the research community and their suggested application if they follow good practices of machine learning reproducibility in order for their claims to be verified and used as a solid base for future work,” said Marques. “Our study recommends a minimum set of practices to be followed before accepting machine-learning-based studies for publication.”  

Study co-authors are Christian Garbin, first author and a Ph.D. candidate, and Nicholas Marques, an M.S. student in data science and analytics and a National Science Foundation Research Traineeship Program scholar, both within the College of Engineering and Computer Science.

“Opioid use disorder is a public health concern of the first magnitude in the United States and elsewhere,” said Stella Batalama, Ph.D., dean, FAU College of Engineering and Computer Science. “Harnessing the power and potential of machine learning to predict and prevent one’s risk of opioid use disorder holds great promise. However, to be effective, machine learning methods must be reliable and reproducible. This systematic review by our researchers provides important recommendations on how to accomplish that.”

– FAU –

About FAU’s College of Engineering and Computer Science:

The FAU College of Engineering and Computer Science is internationally recognized for cutting-edge research and education in the areas of computer science and artificial intelligence (AI), computer engineering, electrical engineering, biomedical engineering, civil, environmental and geomatics engineering, mechanical engineering, and ocean engineering. Research conducted by the faculty and their teams expose students to technology innovations that push the current state-of-the art of the disciplines. The College research efforts are supported by the National Science Foundation (NSF), the National Institutes of Health (NIH), the Department of Defense (DOD), the Department of Transportation (DOT), the Department of Education (DOEd), the State of Florida, and industry. The FAU College of Engineering and Computer Science offers degrees with a modern twist that bear specializations in areas of national priority such as AI, cybersecurity, internet-of-things, transportation and supply chain management, and data science. New degree programs include Master of Science in AI (first in Florida), Master of Science and Bachelor in Data Science and Analytics, and the new Professional Master of Science and Ph.D. in computer science for working professionals. For more information about the College, please visit eng.fau.edu. 

 

About Florida Atlantic University: Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University serves more than 30,000 undergraduate and graduate students across six campuses located along the southeast Florida coast. In recent years, the University has doubled its research expenditures and outpaced its peers in student achievement rates. Through the coexistence of access and excellence, FAU embodies an innovative model where traditional achievement gaps vanish. FAU is designated a Hispanic-serving institution, ranked as a top public university by U.S. News & World Report and a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.fau.edu.

BYLINE: Marlene Naanes

Newswise — New York, NY (July 27, 2023) – Cigarette smokers have higher odds of tobacco dependence than those who vape or use a variety of types of tobacco products, according to a Mount Sinai study published in July in Nicotine & Tobacco Research.

The findings suggest that tailored tobacco cessation programs are needed for people with different tobacco use habits. The researchers identified three clear types of tobacco users: those who predominantly smoke cigarettes, those who predominantly use smokeless tobacco, and those who predominantly use a combination of cigarettes, e-cigarettes, and cigars.

This discovery is important for tailoring tobacco use reduction and cessation programs to have better success. For example, people who mostly smoke cigarettes would be best served by focusing efforts on reducing their tobacco dependence, while others would be best helped with interventions that increase their likelihood of quitting tobacco use by preventing them from transitioning to only, or predominantly, smoking cigarettes, in addition to outright quitting. 

“With the evolving landscape of tobacco product varieties, our findings are important because it is imperative that we understand which types of tobacco uses lead to dependency, informing cessation program designs and increasing their success,” said the study’s senior author, Bian Liu, PhD, Associate Professor of Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai and member of the Institute for Translational Epidemiology and The Tisch Cancer Institute of the Tisch Cancer Center at Mount Sinai.

Given the increasing availability of diverse tobacco products, many individuals are likely to use multiple tobacco products and to engage in product switch and substitution. This has complicated tobacco cessation efforts aimed at reducing the health burden and economic costs associated with tobacco use and dependence. The lack of research in this area highlighted the need to use novel approaches and richer sources of information, such as that from the Population Assessment of Tobacco and Health (PATH) study, to explore and understand tobacco use and tobacco dependence profiles.

In this study, Mount Sinai researchers examined tobacco use profiles across four PATH surveys from 2013 to 2018. The scientists identified tobacco use profiles through intricate analysis and investigated the longitudinal association between tobacco use and dependency, identifying the subgroups with a high risk of dependency.

“As individuals may change their habits over time, future studies should examine patterns of tobacco use changes, including whether people’s changing habits differ by sociodemographic factors, and we should investigate how these changes impact tobacco dependency over time in the context of other smoking behaviors, including attempting to quit, relapse, and smoking cessation,” said the study’s first author, Lihua Li, PhD, Associate Professor of Population Health Science and Policy at Icahn Mount Sinai and member of The Tisch Cancer Institute and Institute for Health Care Delivery Science.

About the Mount Sinai Health System

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, nearly 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.

Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report’s Best Hospitals, receiving high “Honor Roll” status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children’s Hospital among the country’s best in several pediatric specialties.

For more information, visit https://www.mountsinai.org or find Mount Sinai on Facebook, Twitter and YouTube.

Newswise — Young adults whose drinking lands them in the emergency room respond differently to different interventions to reduce their hazardous drinking, and those differences may be driven by certain personal characteristics. In a study published in Alcohol: Clinical and Experimental Research, researchers found that older people with greater severity and acknowledgment of alcohol problems tended to benefit more than others from brief motivational interviewing. Less intensive interventions showed greater benefit to some younger people. The findings may help identify and tailor cost-effective treatment for young adults at high risk for hazardous drinking.

The study identified personal characteristics associated with reduced heavy drinking days following two different interventions to address alcohol use. ‘Brief advice’ provides information about alcohol risks and recommendations to reduce alcohol consumption. ‘Brief motivational interviewing’ is a more intensive intervention, employing empathic, collaborative counseling to help someone find motivation to change behavior. In this study, on average, the brief motivational interviewing protocol took almost 40 minutes and included follow-up sessions one week, one month, and three months after the initial session, while the brief advice intervention was less than four minutes long with no follow-up. Psychologists trained in motivational interviewing conducted both interventions.

Older young adults who scored higher for alcohol use disorder severity and recognized the need to change but were not confident they could change seemed to benefit most from brief motivational interviewing. Those who fit this profile and had higher depression and anxiety levels reported greater short-term benefits from brief motivational interviewing–two fewer heavy drinking days in the first month than those who received brief advice but did not sustain the benefit at 12 months. Those without depression and anxiety reaped longer-term benefits from brief motivational interviewing, reporting lower levels of heavy drinking at one month and one year compared to those who received brief advice.

Younger study participants who had lower severity of alcohol use disorder and did not consider their alcohol use problematic generally seemed to benefit more from brief advice than those older and recognized they had a problem. Those who fit this profile and received brief advice reported three fewer heavy drinking days per month than those who received brief motivational interviewing.

Data came from a study of three hundred 18- to 35-year-olds who presented to a Swiss hospital emergency room with alcohol intoxication between 2016 and 2019. Participants were randomly assigned to receive brief motivational interviewing or brief advice addressing their alcohol use. Subsequently, they periodically reported the number of days they drank heavily, defined as more than 60 grams of pure alcohol–roughly more than four standard U.S. drinks–in one day.

The study authors suggest that young adults with medium severity of alcohol use disorder and high willingness but low confidence for change might receive optimal benefit from brief motivational interviewing and recommend more intensive motivational interviewing for those with more severe alcohol use disorder and mental health issues to prolong the benefit shown by this study.

Who benefits from Brief Motivational Intervention among young adults presenting to the Emergency Department with alcohol intoxication: A moderation analysis using latent classes. J. Gaume, S. Blanc, M. Magill, J. McCambridge, N. Bertholet, O. Hugli. (p. x-xx)

ACER-23-5584.R1

Newswise — Philadelphia, July 19, 2023 – Researchers from Children’s Hospital of Philadelphia (CHOP) and the Perelman School of Medicine at the University of Pennsylvania found that cancer patients who continued to smoke after their diagnosis were significantly more likely to receive treatment for tobacco use when “nudges” to provide tobacco treatment were directed at clinicians through the electronic health record. The findings strengthen the case for using behavioral economics, or targeting predictable patterns in human decision-making to overcome barriers to changes in behavior, to improve outcomes for patients treated for cancer. 

The findings were published online by the Journal of Clinical Oncology.

More than 50% of patients who smoke prior to their cancer diagnosis continue to smoke after they are diagnosed. This can worsen quality of life and accelerate tumor growth. Routine, evidence-based tobacco use treatment (TUT) – usually involving a referral to a smoking cessation clinic for counseling and potentially using medication to help address tobacco use – reduces the risk of death caused by cancer and other health issues. Despite its benefits, only about half of cancer centers identify patient tobacco use and even fewer engage patients directly in adopting a TUT strategy.

To help increase the use of TUT among cancer patients, researchers wanted to explore the use of strategies informed by behavioral economics to improve TUT uptake among patients and help clinicians improve their willingness to engage in TUT for their patients.

“Oncologists are faced with the challenge of responding to each patient’s individual cancer, so we wanted to see if we could develop a strategy for making their lives as easy as possible by providing simple, timely nudges to help patients engage in tobacco use treatment options,” said first author Brian Jenssen, MD, a researcher and primary care pediatrician with the Division of General Pediatrics at CHOP, a faculty member with PolicyLab and Clinical Futures at CHOP, a senior fellow at the Leonard Davis Institute of the University of Pennsylvania, and a member of the Abramson Cancer Center’s Tobacco and Environmental Carcinogenesis Program. “Clinicians can help their patients find ways of improving their health by helping them quit smoking in a nonjudgmental way.”

In this study, conducted between June 2021 and July 2022, the researchers implemented a randomized clinical trial across 11 sites in the Penn Medicine Abramson Cancer Center (ACC) network. The research team designed and delivered electronic health record-based “nudges” – brief messages intended to remind clinicians and their patients to integrate tobacco treatment into their care plan – in four different combinations: patient only, clinician only, patient and clinician, and usual care with no nudges. These nudges were designed to counteract mental biases that work against TUT, such as concerns about the safety of tobacco treatments versus their potential benefits, and the potential distraction from medical treatment. In total, 246 ACC clinicians were randomized in 95 clusters involving 2,146 eligible cancer patients who smoked while receiving cancer care.

The clinician nudge led to a significant increase in implementation of TUT compared with usual care (35.6% vs. 13.5%). Patient nudges did not impact implementation of TUT, suggesting that clinical staff are more effective targets to collaborate with their patients to adopt TUT strategies and that there is a need to continue to explore ways to improve patient-facing methods to increase TUT engagement.

“This study shows that a behavioral economics ‘nudge’ strategy can increase tobacco use treatment in the oncology setting, which we hope will help more patients with cancer control their tobacco dependence and enjoy better cancer care outcomes,” said senior author Frank T. Leone, MD, director of the Comprehensive Smoking Treatment Program at Penn Medicine, a professor of Pulmonary Medicine in the Perelman School of Medicine, and a member of the Tobacco and Environmental Carcinogenesis Program at the ACC. “We look forward to continuing to build on this research and further increase engagement with tobacco use treatment in the oncology setting.”  

This study was supported by National Cancer Institute grant (P50 CA244690), led by principal investigators Rinad S. Beidas, PhD, now at Northwestern University, and Justin Bekelman, MD, and Robert Schnoll, PhD, both at Penn.  

Jenssen et al, “A Cluster Randomized Pragmatic Clinical Trial Testing Behavioral Economic Implementation Strategies to Improve Tobacco Treatment for Cancer Patients Who Smoke.” J Clin Oncol. Online July 19, 2023. DOI: 10.1200/JCO.23.00355.

About Children’s Hospital of Philadelphia: A non-profit, charitable organization, Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, the 595-bed hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. The institution has a well-established history of providing advanced pediatric care close to home through its CHOP Care Network, which includes more than 50 primary care practices, specialty care and surgical centers, urgent care centers, and community hospital alliances throughout Pennsylvania and New Jersey, as well as an inpatient hospital with a dedicated pediatric emergency department in King of Prussia. In addition, its unique family-centered care and public service programs have brought Children’s Hospital of Philadelphia recognition as a leading advocate for children and adolescents. For more information, visit https://www.chop.edu. 

Newswise — CHAPEL HILL, N.C. – In North Carolina, e-cigarettes continue to be the most popular tobacco product among young people. Since e-cigarettes were first made available in 2011, rates of youth e-cigarette use in North Carolina have increased, impacting 20.9% of high school students and 6.1% of middle school students in 2019. Nationwide, lung damage related to use of electronic cigarettes has risen sharply since 2020, with many suffering from continued respiratory issues.

In 2019, North Carolina filed a lawsuit against JUUL Labs, Inc., for their purported role in the state’s vaping epidemic among youth and young adults, becoming the first state to do so. JUUL is the largest e-cigarette manufacturer in the United States and, at the time, was the most popular e-cigarette brand in the state.

The maker of electronic cigarettes consented to settle with North Carolina in 2021. As part of the consent order, JUUL was required to alter its business practices significantly and pay $40 million to the NC Department of Health and Human Services (NCDHHS) to support initiatives that aid smokers in quitting, fight e-cigarette addiction, and advance scientific research.

“In recent years, we have noted a stark increase in electronic cigarette use among middle and high school students,” said Leah Ranney, PhD, MA, research associate professor in the Department of Family Medicine and the director of University of North Carolina’s Tobacco Prevention and Evaluation program (TPEP). “This contract will support activities to help reduce this alarming trend among North Carolinians,”

A portion of the settlement funding was awarded to TPEP. The two-year, $887,431 contract will help researchers, school personnel, parents, and public health practitioners, to better understand youth and young adult vaping (e-cigarette) and emerging tobacco product trends in North Carolina. The contract was awarded by the NC DHHS Tobacco Prevention and Control Branch (TPCB) and the effort will be led by Ranney at UNC.

For more than 20 years, TPEP has worked collaboratively with the TPCB to conduct program evaluation on NC tobacco control programs like the QuitlineNC and to analyze responses from school based the NC Youth Tobacco Survey, one of only 2 sources for NC youth risk behavior data. UNC TPEP will use a variety of qualitative and quantitative data collection strategies to evaluate trends in youth and young adult vaping (e-cigarette) and emerging tobacco products.

“This contract will provide critically important data on the current perceptions of tobacco products, including e-cigarettes, within our state,” said Adam Goldstein, MD, MPH, director of the University of North Carolina Tobacco Intervention Programs. “Learning more about current e-cigarette perceptions among multiple stakeholders, including teachers, could point us to better ways to intervene early and ultimately improve the life-long heath of North Carolinians.”

Beginning July 1, 2023, this new project is one of the many funded through the JUUL settlement funds that seek to promote cessation, prevent e-cigarette addiction, and research e-cigarettes across North Carolina.

“While we still do not know all the short and long-term health effects of vaping, everyone agrees that youth should not use any tobacco product, including vapes,” said Goldstein, who is also the Elizabeth and Oscar Goodwin Distinguished Professor in the Department of Family Medicine.

Newswise — Co-existing use of alcohol and cannabis can lead to negative outcomes such as the development of a substance-use disorder, poor academic and occupational performance, and psychiatric disorders when compared to use of either drug alone. New research that examines simultaneous alcohol/cannabis use has found higher levels of drinking after 18 months. These results and others will be shared at the 46th annual scientific meeting of the Research Society on Alcohol (RSA) in Bellevue, Washington.

“The prevalence of concurrent use of alcohol and cannabis is increasingly recognized as a risk factor for experiencing a number of mental health problems,” said Eric D. Claus, associate professor of biobehavioral health. “For this study, we used data] from a larger longitudinal study on heavy drinkers [to identify 88 individuals who reported using only alcohol at baseline and 24 who reported use of alcohol and cannabis on at least 50% of drinking days at baseline.” Participants also completed neuroimaging sessions, which included a task of stress and alcohol cue reactivity and a stop signal task.

“We found that the concurrent use group had higher levels of drinking over the past month at an 18-month follow-up visit, he said. “If greater drinking intensity continues and the individuals experience more consequences, it seems reasonable to hypothesize that drinking levels could continue to exceed National Institute on Alcohol Abuse and Alcoholism drinking guidelines five years out, but this needs to be tested further.”

Claus will expand on his findings at the RSA meeting on Wednesday, 28 June 2023.

“Concurrent use of alcohol and cannabis may be associated with an increased response in neural circuits associated with the processing of stress compared to use of alcohol alone,” said Claus. Furthermore, he added, this finding underscores the importance of targeting prevention efforts for individuals who report concurrent alcohol and cannabis use. 

“Given the rapidly changing landscape of cannabis legislation in the U.S.,” noted Clause, “it will be particularly important to continue research in this area to better understand the risk factors that predict who is likely to engage in concurrent use of alcohol and cannabis as well as to characterize the mechanisms that lead to varying trajectories of use among individuals reporting concurrent use.”

###

Claus will present these findings, “Concurrent alcohol and cannabis use is associated with increased consumption of alcohol over time,” during the RSA 2023 meeting in Bellevue, Washington on Wednesday, 28 June 2022. More information can be found at RSoA on Twitter @RSAposts.

Newswise — Alcohol craving is associated with relapse following alcohol use disorder (AUD) treatment. A new study is the first to examine how distinct experiences of interpersonal racial discrimination contribute to elevated alcohol craving. Findings will be shared at the 46^th annual scientific meeting of the Research Society on Alcohol (RSA) in Bellevue, Washington.

“Cravings can be intense and challenging to not act on,” said Sarah L. Pedersen, associate professor of psychiatry and psychology at the University of Pittsburgh. “Research has also shown that stress increases craving for alcohol and can precipitate a lapse or relapse following AUD treatment. My team is invested in identifying influences of inequities in alcohol-related problems and, given prior research showing associations between general stress and craving, we wanted to understand how specific experiences of discrimination may increase alcohol craving.”

Pedersen will discuss her study’s findings at the RSA meeting on Sunday, 25 June 2023.

Data for this study were drawn from a larger ongoing alcohol administration study: 140 young adults (44% self-identified as Black or African American, 56% self-identified as White or European American) who consume alcohol at least weekly completed a survey and a 17-day assessment of acute alcohol craving as well as experienced microaggressions.

“The Racial and Ethnic Microaggressions Scale is a 28-item self-report measure examining five domains of racial discrimination experiences during the previous six months,” explained Pedersen. “Examples include: ‘Someone told me that they don’t see color,’ ‘I was ignored at school or work because of my race,’ and ‘someone assumed I was poor because of my race.’”

Black individuals reported higher average levels of alcohol craving across the 17-day assessment window compared to White individuals.

Pedersen believes that experiences of interpersonal racial discrimination contribute to increases in craving alcohol to cope with racial stress. “These results have treatment implications related to promoting the development of emotion regulation skills and strategies after experiencing racial discrimination, and policy and training implications regarding the deleterious effects of exposure to interpersonal racial discrimination,” she said. Additional analyses by Pedersen’s team will integrate momentary experiences of discrimination and subsequent alcohol craving in a naturalistic environment.

“My team uses a community-engaged approach and we have worked closely with community members to understand their needs, experiences, and ideas for research,” added Pedersen. “Our community partners are centered in our research and have been incredible contributors to this study; including the interpretation and presentation of these results.”

###

Pedersen will present these findings, “Examination of interpersonal racial discrimination in relation to naturalistic alcohol craving,” during the RSA 2023 meeting in Bellevue, Washington on Sunday, 25 June 2023. More information can be found at RSoA on Twitter @RSAposts.

UNDER EMBARGO UNTIL
WEDNESDAY, JUNE 14 at 8:00 PM EST

Newswise — New York, NY (June 13) Men were significantly more vulnerable than women to overdose deaths involving opioid and stimulant drugs in 2020-2021, according to a new study analyzing data from across the United States. The study found that men had a two–three times greater rate of overdose mortality from opioids (like fentanyl and heroin) and psychostimulants (like methamphetamine and cocaine). While it is known that men use drugs at higher rates than women, the researchers found that this alone does not explain the gap in overdose deaths, noting that biological, behavioral, and social factors likely combined to increase the mortality risk for men.

The study, published in Neuropsychopharmacology, was led by investigators at the Icahn School of Medicine at Mount Sinai and the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

“These data emphasize the importance of looking at the differences between men and women in a multilayered way,” said Eduardo R. Butelman PhD, Assistant Professor of Psychiatry at Icahn Mount Sinai and a lead author on the study. “Moving forward, it will be important for researchers to continue to investigate how biology, social factors, and behaviors intersect with sex and gender factors, and how all of these can impact addictive drug misuse and overdose deaths.”

In 2021, nearly 107,000 people died of a drug overdose, largely driven by potent, illicit fentanyl, which now contaminates the drug supply. Data have consistently shown that the rate of drug overdose deaths is significantly higher for men than women. In addition, data suggest that men are more likely than women to use almost all types of illicit drugs. Building on these data, researchers sought to determine the extent to which this sex difference in overdose mortality varies by drug, state, and age, and to investigate whether the increased rate of overdose death among men held true when controlling for higher rates of drug misuse among men compared to women. 

To do so, researchers conducted a state-by-state analysis of nationally representative data on overdose death among people aged 15–74 from 2020-2021 in the United States, using the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) platform. The scientists also used state-level, nationally representative data from the National Surveys on Drug Use and Health (NSDUH) to estimate and control for rates of drug misuse (taking drugs in a way not recommended by a health care provider) among men compared to women. The NSDUH is conducted annually by the Substance Abuse and Mental Health Services Administration.

For specific drugs, and after controlling for the sex-specific rate of drug misuse, the researchers found that the overall rates of drug overdose death by sex from 2020-2021 were:

• Synthetic opioids (e.g., fentanyl):0 deaths per 100,000 people for men, compared to 11.1 for women
• Heroin:5 deaths per 100,000 people for men, compared to 2.0 for women
• Psychostimulants (e.g., methamphetamine):0 deaths per 100,000 people for men, compared to 5.6 for women
• Cocaine:6 deaths per 100,000 people for men, compared to 4.2 for women

The higher overdose death rate in men was observed across the lifespan (ages 15-74 overall) and was consistent across states, even after accounting for other demographic factors, such as household net worth. In addition, when the authors analyzed the data by 10-year age groups, they found that for overdose deaths involving synthetic opioids like fentanyl, men had greater rates than women across each group within the entire 15-74 age range measured in the study. For the three other drug categories assessed, men also had greater overdose mortality rates compared to women across the lifespan, with few exceptions. Due to limited data, for heroin, the youngest and oldest age groups (age ranges 15-24 and 65-74) were excluded from analysis; for psychostimulants and cocaine, the oldest age group (age range 65-74) was excluded from analysis.

While researchers also found that men reported misusing drugs more than women, the magnitude of difference recorded for overdose mortality between men and women was substantially greater than the difference of reported drug misuse. For example, by comparing the data from CDC WONDER and NSDUH, the researchers found that men had a 2.8 greater rate of cocaine overdose mortality compared to women, though men only had a 1.9 greater rate of cocaine misuse compared to women.

The authors hypothesize that it is a combination of biological factors (e.g., men may have a greater vulnerability to the toxicity of drugs than women), behavioral factors (e.g. men may use these drugs in a riskier way than women), as well as other social- and gender-related factors.

“Future research that investigates the interactive biological, behavioral and social mechanisms that underlie differential risks of overdose mortality in men versus women could eventually point to personalized strategies to mitigate the progression or severity of substance use disorders, and thereby decrease the public health crisis caused by overdose mortality,” said Dr. Butelman.

About the Mount Sinai Health System
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, nearly 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advanced health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. 

Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report‘s Best Hospitals, receiving high “Honor Roll” status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children’s Hospital among the country’s best in several pediatric specialties.

For more information, visit https://www.mountsinai.org or find Mount Sinai on Facebook, Twitter and YouTube.

###