Category: From Newswise – Substance Abuse

Newswise — In a recently published commentary, UK HealthCare physicians call for standard-of-care treatment for opioid use disorder (OUD) among patients who are incarcerated.

The viewpoint article by Anna-Maria South, M.D., Laura Fanucchi, M.D., and Michelle Lofwall, M.D., published in JAMA April 24 highlights the barriers to initiating medication for opioid use disorder (MOUD) among people who are incarcerated.

For patients with opioid use disorder, medications such as buprenorphine and methadone are considered by the medical community as standard of care treatments, as they alleviate withdrawal symptoms, reduce cravings and pain, decrease infections, and lower the risk of mortality. However, the use of these medications is often restricted in U.S. prisons and jails, with only a few states mandating their use in the carceral system. 

The physicians’ article draws attention to the significant moral distress experienced by doctors when patients who are incarcerated need to be hospitalized due to serious medical complications resulting from untreated opioid use disorder, but they are unable to provide them with the best treatment.

The article also highlights the fact that denying patients standard-of-care treatments because they are incarcerated violates medical ethics, constitutional amendments and the Americans with Disabilities Act (ADA) and emphasizes the need for physician advocacy.

“Incarcerated people with opioid use disorder are among the most vulnerable patient populations that also have the least ability to advocate for themselves,” said South, an assistant professor in UK College of Medicine’s Division of Hospital Medicine and an attending physician on the Addiction Consult and Education Services. “We as physicians have a powerful voice for advocacy to make substantial change. We need to educate ourselves on the rights that our patients have and where we can go to advocate for them.”

South is the paper’s first author and UK’s 2022 Bell Addiction Medicine Scholar. South’s work on this article was supported by the Bell Alcohol and Addictions Scholar Program.

Read the full JAMA article here.

UK HealthCare is the hospitals and clinics of the University of Kentucky. But it is so much more. It is more than 10,000 dedicated health care professionals committed to providing advanced subspecialty care for the most critically injured and ill patients from the Commonwealth and beyond. It also is the home of the state’s only National Cancer Institute (NCI)-designated cancer center, a Level IV Neonatal Intensive Care Unit that cares for the tiniest and sickest newborns, the region’s only Level 1 trauma center and Kentucky’s top hospital ranked by U.S. News & World Report.  

As an academic research institution, we are continuously pursuing the next generation of cures, treatments, protocols and policies. Our discoveries have the potential to change what’s medically possible within our lifetimes. Our educators and thought leaders are transforming the health care landscape as our six health professions colleges teach the next generation of doctors, nurses, pharmacists and other health care professionals, spreading the highest standards of care. UK HealthCare is the power of advanced medicine committed to creating a healthier Kentucky, now and for generations to come. 

Title 42, the United States pandemic rule that had been used to immediately deport hundreds of thousands of migrants who crossed the border illegally over the last three years, has expired. Those migrants will have the opportunity to apply for asylum. President Biden’s new rules to replace Title 42 are facing legal challenges. The US Homeland Security Department announced a rule to make it extremely difficult for anyone who travels through another country, like Mexico, to qualify for asylum. Border crossings have already risen sharply, as many migrants attempted to cross before the measure expired on Thursday night. Some have said they worry about tighter controls and uncertainty ahead. Immigration is once again a major focus of the media as we examine the humanitarian, political, and public health issues migrants must face. 

Below are some of the latest headlines in the Immigration channel on Newswise.

Expert Commentary

Experts Available on Ending of Title 42

George Washington University Experts on End of Title 42

‘No one wins when immigrants cannot readily access healthcare’

URI professor discusses worsening child labor in the United States

Biden ‘between a rock and a hard place’ on immigration

University of Notre Dame Expert Available to Comment on House Bill Regarding Immigration Legislation, Border Safety and Security Act

American University Experts Available to Discuss President Biden’s Visit to U.S.-Mexico Border

Title 42 termination ‘overdue’, not ‘effective’ to manage migration

Research and Features

Study: Survey Methodology Should Be Calibrated to Account for Negative Attitudes About Immigrants and Asylum-Seekers

A study analyses racial discrimination in job recruitment in Europe

DACA has not had a negative impact on the U.S. job market

ASBMB cautions against drastic immigration fee increases

Study compares NGO communication around migration

Collaboration, support structures needed to address ‘polycrisis’ in the Americas

TTUHSC El Paso Faculty Teach Students While Caring for Migrants

Immigrants Report Declining Alcohol Use during First Two Years after Arriving in U.S.

How asylum seeker credibility is assessed by authorities

Speeding up and simplifying immigration claims urgently needed to help with dire situation for migrants experiencing homelessness

Training Individuals to Work in their Communities to Reduce Health Disparities

‘Regulation by reputation’: Rating program can help combat migrant abuse in the Gulf

Migration of academics: Economic development does not necessarily lead to brain drain

How has the COVID-19 pandemic affected immigration?

Immigrants with Darker Skin Tones Perceive More Discrimination

May is Mental Health Awareness Month. Nearly one in five Americans live with a mental health condition, according to the National Institute of Mental Health. Many factors come into play when it comes to your mental health, such as your neighborhood, your daily routine, and your genetics. According to the American Hospital Association, this is a time to raise awareness of and reduce the stigma surrounding behavioral health issues, as well as highlight the ways in which mental illness and addiction can affect all of us. Recently, the Department of Health and Human Services (HHS) under the Biden Administration launched “988,” the Suicide Prevention Lifeline. It’s important to remember that you are not alone.

Below are some of the latest research headlines in the Mental Health channel.

APA panel issues recommendations for adolescent social media use

Fame-seeking mass shooters more likely to plan ‘surprise’ attacks, and the novelty of their locations and targets brings added fame

Researchers Explore Effect of Instagram, TikTok on Psychological Well-Being

Cognitive behavioral therapy lessens post-viral fatigue after COVID-19

Majority of Nurses Attribute Well-Being Struggles to Staffing Shortages (embargoed until 11-May-2023 7:00 AM EDT)

Therapy sessions benefit mothers, children in homeless shelter (embargoed until 11-May-2023 9:00 AM EDT)

Older people have better mental well-being than 30 years ago

How online art viewing can impact our well-being

Clinicians must look beyond physical symptoms to care for people with deep-seated trauma

Impaired verbal memory increases psychiatric patients’ risk of hospitalization

At-home yoga reduces anxiety, improves short-term memory

Newswise — Burden of opioid toxicity death in the fentanyl-dominant era for people who experience incarceration in Ontario, Canada, 2015–2020: a whole population retrospective cohort study – Find the study here: https://bmjopen.bmj.com/content/13/5/e071867

This retrospective cohort study looked at mortality due to opioid toxicity among people who experienced incarceration in Ontario between 2015 and 2020, during the fentanyl-dominant era.

Study results showed the risk of opioid toxicity death is many times higher for people who experience incarceration compared with others in Ontario. Risk is markedly elevated in the week after release, and women who experience incarceration have a substantially higher SMR than men who experience incarceration. Initiatives to prevent deaths should consider programs and policies in correctional facilities to address high risk on release.

Newswise — A new study led by a Johns Hopkins Bloomberg School of Public Health researcher found that the percent of patients treated for opioid use disorder with methadone significantly decreased their use of fentanyl during a year of treatment. The percent who tested positive for fentanyl declined on average from 21.8 percent in week one to 17.1 percent in week 52.

The average heroin positivity rate also declined, from 8.4 percent to 4.3 percent. For both heroin and fentanyl, the biggest declines were seen in the first 10 weeks of treatment. The average positivity for methamphetamine and cocaine did not significantly change over the course of 52 weeks of treatment.

For their study, the researchers analyzed urine specimens for illicit substances—including fentanyl, heroin, cocaine, and methamphetamine—among patients receiving treatment at methadone clinics from over 16,000 individuals in 10 states from January 1, 2017, to December 31, 2021. The researchers analyzed urine specimens covering the first 52 observed weeks of an individual’s treatment. 

The study was published online May 9 in the journal Addiction.

Methadone is approved by the Food and Drug Administration to treat symptoms of opioid use disorder, including cravings and withdrawal.

“Patients are increasingly testing positive for fentanyl and other illicit drugs at the start of treatment and our study suggests that patients significantly decrease their use of illicit opioids during a year in methadone treatment,” says Brendan Saloner, PhD, Bloomberg Associate Professor of American Health in the Department of Health Policy and Management and the study’s lead author. “At the same time, the prevalence of methamphetamine and cocaine use is on the rise and is not generally decreasing during a year in methadone treatment. These findings will help clinicians identify patients who are at greater risk and can offer additional support.”

The researchers analyzed anonymized urine samples from Millennium Health’s proprietary database. Millennium Health is a drug-testing laboratory that services all 50 states. The study sample drew from patients diagnosed with opioid use disorder who were receiving methadone treatment and who had at least three valid urine specimens in the database. The researchers used data from Alaska, Arizona, Florida, Illinois, Kentucky, Minnesota, New Mexico, Ohio, Virginia, and Washington. The analysis included 194,333 specimen samples from 16,386 individual patients.

The researchers found that across the five-year study period the first urine specimens collected indicated increasing fentanyl positivity rates in the broader population, from 13.1 percent in 2017 to 53 percent in 2021. The positivity rate for methamphetamine also increased, from 10.6 percent to 27.2 percent, as did cocaine, from 13.8 percent to 19.5 percent.

Additional analyses found that fentanyl positivity was significantly higher for males compared to females. It was also significantly higher in the age group 18–24 than in all other age groups. Fentanyl positivity rates were highest in Ohio, Illinois, Arizona, Kentucky, and Minnesota. Alaska had the highest heroin and methamphetamine positivity. 

“Methadone treatment can have tremendous success reducing fentanyl and heroin use in individuals, but this study shows we aren’t addressing the complexity of polysubstance use,” says Saloner. “The findings clearly sound an alarm bell that we need more tools to support other types of substance use.”

“Polydrug Use Among Patients on Methadone Medication Treatment: Evidence from Urine Drug Testing to Inform Patient Safety” was written by Brendan Saloner, Penn Whitley, Eric Dawson, Steven Passik, Adam Gordon, and Bradley Stein.

The study was supported by funding from National Institute on Drug Abuse #R01DA045800.

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Newswise — The Government of Canada is committed to improving the health and mental wellbeing of children and youth in Canada. Early childhood experiences influence a child’s mental health for life—and with 70% of mental health and substance use problems having origins in childhood, understanding how to better identify and treat young children at risk of developing or living with a mental health issue is crucial.

Today, the Honourable Carolyn Bennett, Minister of Mental Health and Addictions and Associate Minister of Health, announced an investment of $6.5 million over five years for six projects funded through the Canadian Institutes of Health Research (CIHR) Mental Health in the Early Years (MHITEY) initiative. MHITEY, led by the CIHR’s Institute of Human Development, Child and Youth Health, will help to advance Canada’s mental health strategy by identifying solutions for safe and equitable programs and services for diverse populations, and through adopting, adapting and improving the use of evidence-based practices in clinical, community, and public health settings.

The funded research projects will create early childhood development assessment tools and training materials for Indigenous communities in Canada; a program to support mothers who use substances and their young children; an effective method for communities to develop their own “early years” mental health programs to ensure at-risk children and families get the right support where and when they need it; and two online apps to support parents and their preschool-aged children overcome challenges such as anxiety, anger, depression and sleep problems.

Today’s announcement builds on the investments made by the Government of Canada in Budget 2023, including our investment of nearly $200 billion over 10 years to improve health care services for Canadians, reduce surgical backlogs, support health workers, and improve integrated mental health and substance use services. We will continue to do whatever it takes to ensure that all Canadians, including children and youth, have the mental health and substance use supports they need and deserve.

Quotes

“Having a healthy childhood is so important for laying down the foundation for the rest of your life. We are committed to improving the mental wellbeing and health services provided to children in Canada. These projects funded today will help improve access to care and support the mental health of young children exposed to experiences, such as family violence, abuse, poverty, and low income. Congratulations to all the grant recipients.”

The Honourable Carolyn Bennett
Minister of Mental Health and Addictions and Associate Minister of Health

“There is a great need for more inclusive access to mental health services and community-based prevention and treatment strategies across Canada. We are so fortunate to have CHEO right here in Ottawa who works with community organizations to offer mental health services for children and youth—including counselling for addictions and eating disorders and support for parents and caregivers.”

The Honourable David J. McGuinty
Member of Parliament for Ottawa South

“Supporting research that will enable provision of evidence-based, culturally appropriate interventions that are readily available for young children and their caregivers can have a positive impact on childhood mental health and decrease future health and social risks. The work of the MHITEY teams will support Canada’s continued progress in expanding and implementing solutions to support child and family mental health.”

Dr. Christine Chambers
Scientific Director of the CIHR Institute of Human Development, Child and Youth Health

“Depression, anxiety, eating disorders and other mental illnesses in kids have grown sharply in this era of social media and mobile phones, only to be exacerbated by the impacts of the COVID-19 pandemic. The  daily experiences on the frontlines at  CHEO are supported by our cutting-edge mental health research that clearly illustrates too many kids are not okay. Investments like this in childhood mental health research, along with increased federal funding to right-size pediatric health care, are needed so that CHEO can continue to meet growing demands and provide evidence-based, innovative health care for our kids.”

Dr. Jason Berman
CEO and Scientific Director, CHEO Research Institute, and Vice-President, Research
CHEO

Quick facts

• 1 in 5 Canadians experience mental health or addiction problems in any given year. Currently, fewer than 20% of the 1.2 million children experiencing mental health issues are receiving appropriate treatment and care.

• CIHR-IHDCYH is investing in research targeted at addressing mental health in the early years.

• The MHITEY initiative comprised of three funding opportunities.

• The five team grants received up to $1,250,000 each and will fund implementation science research in early childhood mental health to help understand how to improve evidence-based mental health interventions for young children (ages 0-5) and their caregivers. Implementation science is the study of how to put evidence-based interventions into practice.

• The Knowledge Development and Exchange (KDE) Hub received $500,000 to support the five teams by providing knowledge mobilization expertise and support through the expansion of their existing child and youth focused mental health work. The KDE Hub is funded by the Public Health Agency of Canada.

At the Canadian Institutes of Health Research (CIHR) we know that research has the power to change lives. As Canada’s health research investment agency, we collaborate with partners and researchers to support the discoveries and innovations that improve our health and strengthen our health care system.

Newswise — WASHINGTON (May 2, 2023)–A new study found a declining proportion of DATA-waivered clinicians prescribed any buprenorphine between 2017 and 2021. While the number of waivered clinicians increased significantly during the five-year window, only one out of three prescribed any buprenorphine as of May 2021. Furthermore, the majority of prescriptions were written by clinicians who specialize in treating opioid use disorder.

The research letter published in JAMA April 27 notes that the Drug Addiction Treatment Act (DATA) of 2000 created a pathway for clinicians to obtain a “waiver” to prescribe buprenorphine (also known by the brand name Suboxone) outside of an opioid treatment program. While originally intended as a strategy to increase access to treatment, researchers at the George Washington University noted that recent policies are now focused on reducing or removing waiver requirements to prescribe buprenorphine to facilitate provider participation. 

“With the removal of the waiver entirely in the 2023 Consolidated Appropriations Act, this study brings into question the assumption that eliminating the waiver will lead to substantial increases in buprenorphine access,” the authors said. “While removal of this barrier may make it easier for clinicians to begin prescribing, additional investments may be needed to build and support clinicians treating opioid use disorder.”

According to the Centers for Disease Control and Prevention the number of overdose deaths in the US increased by nearly 30% from 2019 to 2020. Most of the drug overdose deaths in 2020 involved an opioid. Buprenorphine is used to treat opioid use disorder and increasing access to this medication is essential in the US strategy to fight the opioid crisis, according to the authors.

The research letter, “Changes in Waivered Clinicians Prescribing Buprenorphine and Prescription Volume by Patient Limit,” was published in JAMA by Clese Erikson and Qian Luo, both at the GW Fitzhugh Mullan Institute for Health Workforce Equity.

-GW-

Newswise — Strategies to treat pain without triggering dangerous side effects such as euphoria and addiction have proven elusive. For decades, scientists have attempted to develop drugs that selectively activate one type of opioid receptor to treat pain while not activating another type of opioid receptor linked to addiction. Unfortunately, those compounds can cause a different unwanted effect: hallucinations. But a new study led by Washington University School of Medicine in St. Louis has identified a potential route to pain relief that neither triggers addiction nor activates the pathway that causes hallucinations.

The research is published May 3 in the journal Nature.

Painkilling drugs such as morphine and oxycodone, as well as illegal street drugs such as heroin and fentanyl, activate what are known as mu opioid receptors on nerve cells. Those receptors relieve pain but also cause euphoria — the feeling of being high — and that feeling contributes to addiction. An alternative strategy is to target another opioid receptor, called the kappa opioid receptor. Scientists attempting to make drugs that target only the kappa receptor have found that they also effectively relieve pain, but they can be associated with other side effects such as hallucinations.

Researchers at the Center for Clinical Pharmacology at Washington University School of Medicine and the University of Health Sciences & Pharmacy, also in St. Louis, have identified the potential mechanisms behind such hallucinations, with the goal of developing painkillers without this side effect. Using electron microscopes, they identified the way that a natural compound related to the salvia plant selectively binds only to the kappa receptor but then causes hallucinations.

“Since 2002, scientists have been trying to learn how this small molecule causes hallucinations through kappa receptors,” said principal investigator Tao Che, PhD, an assistant professor of anesthesiology. “We determined how it binds to the receptor and activates potential hallucinogenic pathways, but we also found that other binding sites on the kappa receptor don’t lead to hallucinations.”

Developing new drugs to target these other kappa receptor binding sites may relieve pain without either the addictive problems associated with older opioids or the hallucinations associated with the existing drugs that selectively target the kappa opioid receptor.

Targeting the kappa receptor to block pain without hallucinations would be an important step forward, according to Che, because opioid drugs that interact with the mu opioid receptor have led to the current opioid epidemic, causing more than 100,000 overdose deaths in the U.S. in 2021.

“Opioids, especially synthetic opioids such as fentanyl, have contributed to far too many overdose deaths,” Che said. “There’s no doubt we need safer pain-relieving drugs.”

Che’s team, led by first author Jianming Han, PhD, a postdoctoral research associate in Che’s laboratory, found that a class of signaling proteins called G proteins cause the kappa opioid receptor to activate several different pathways.

“There are seven G proteins linked to the kappa receptor, and although they are very similar to each other, the differences between the proteins may help explain why some compounds can cause side effects such as hallucinations,” Han said. “By learning how each of the proteins binds to the kappa receptor, we expect to find ways to activate that receptor without causing hallucinations.”

The function of the G proteins has largely been unclear until now, particularly the protein that activates the pathway lined to hallucinations.

“All of these proteins are similar to one another, but the specific protein subtypes that bind to the kappa receptor determine which pathways will be activated,” Che said. “We have found that the hallucinogenic drugs can preferentially activate one specific G protein but not other, related G proteins, suggesting that beneficial effects such as pain relief can be separated from side effects such as hallucinations. So we expect it will be possible to find therapeutics that activate the kappa receptor to kill pain without also activating the specific pathway that causes hallucinations.”

Newswise — Psilocybin is a hallucinogenic compound found in about 200 mushroom species, including the liberty cap (Psilocybe semilanceata). For millennia, our ancestors have known and used this substance, and in recent years, it has received renewed interest from scientific researchers and therapists.

The substance has the potential to revolutionize the way we treat conditions such as severe depression and substance addiction, according to many. This is also the opinion of University of Southern Denmark researchers Himanshu Khandelia and Ali Asghar Hakami Zanjani from the Department of Physics, Chemistry and Pharmacy.

The two researchers have recently published the scientific paper The Molecular Basis of the Antidepressant Action of the Magic Mushroom extract, Psilocin. The article is the third in a series on the same topic from the two researchers (Interaction of psychedelic tryptamine derivatives with a lipid bilayer and Magic mushroom extracts in lipid membranes). The newest study’s co-authors are Teresa Quynh Tram Nguyen and Luise Jacobsen. The work is supported by the Lundbeck Foundation and the Novo Nordisk Foundation.

Binds stronger than serotonin

“My interest was piqued when I heard a podcast about treating smoking addiction with psilocybin. And since psilocybin mushrooms grow everywhere in Denmark – I picked some in Svanninge Bakker – it wasn’t difficult to start our research”, said Himanshu Khandelia.

Together with Ali Asghar Hakami Zanjani, he is interested in understanding what happens at the molecular level when psilocybin enters the body, is converted to psilocin, and reaches the brain.

“Previous research has shown that psilocin binds to serotonin receptors in the brain. We show that psilocin binds stronger than serotonin to a 5-HT_2AR serotonin receptor. This knowledge can be used if you want to design a drug that acts like psilocybin,” explained Ali Asghar Hakami Zanjani.

The two researchers are neither neuroscientists nor pharmacists, so they currently have no plans on conducting clinical trials or designing new drugs. Their research is about studying and describing what happens at the molecular level when psilocin meets a brain cell, penetrates its membrane, and binds to receptors.

“I would be very happy if society can use our research. Maybe someone will take this further and create a molecule that can be used in medical treatment for conditions like depression,” says Himanshu Khandelia.

Zanjani and Khandelia plan to continue their research in this area, and are now investigating the mechanism by which the binding of the compounds to the receptor triggers psycho-active responses.

The time is more favorable than it has been in a long time for researchers who want to explore psilocybin treatments for conditions such as depression, addiction, anorexia, and PTSD.

Since the 1960s, many countries’ health authorities have had strict bans on researching hallucinogenic substances like psilocybin and LSD.

Prior to that, Swiss chemist Albert Hoffman had isolated psilocybin and psilocin from the P. mexicana mushroom in 1959, and the pharmaceutical company he worked for marketed and sold pure psilocybin to doctors and therapists who could then treat their patients with it.

Towards the end of the 1960s, many countries, especially the United States, tightened their legislation on psychoactive substances, and this also affected research on psilocybin and similar substances, which has been largely stagnant since the 1960s until a few years ago.

Today, countries like the United States, England, and Denmark are again active in the research field – now with a more cautious approach.

Hallucinations and the feeling of being disconnected from the world will come along whether one eats a psilocybin mushroom to take a trip or one takes the substance in a medically prescribed tablet, and this calls for caution, explains Ali Asghar Hakami Zanjani:

“Research shows that you experience something different. It is a form of hallucination. The characteristic is that patients may get a whole new perspective on their situation: for example, a terminally ill cancer patient may lose their fear of dying soon and instead experience acceptance of their life situation. Such sessions should take place in safe and guiding settings led by trained therapists. Today, no one would recommend just eating some mushrooms at home in their own living room”.

More psychedelic research at University of Southern Denmark: 

Ass. Professor Mikael Palner, Dept. of Clinical Research, also researches psychedelic substances. He and his students focus on testing substances on rats. One line of this research involves studying the pharmacokinetics of different psychedelic substances, such as LSD, psilocybin, and DMT in rats. Another line aims to investigate whether psilocybin can treat rats with various mental disorders such as anxiety, compulsive behaviors, or PTSD. https://www.palnerlab.org/

Newswise — At the end of 2022, the federal government eliminated the “X waiver,” a major hurdle to providing addiction treatment, but progress needs to be continued, according to the authors of a new Perspective piece published in the New England Journal of Medicine. The X waiver required a special license and uncompensated training for physicians and other prescribers, creating a regulatory barrier to offering lifesaving buprenorphine treatment for opioid use disorder. Ending the X, the authors write, is necessary but not sufficient to achieve overdose-prevention goals.

Sarah Wakeman, MD, Medical Director for Substance Use Disorder at Mass General Brigham, and her co-author Leo Beletsky, JD, MPH, University of California, San Diego School of Medicine, call for several additional measures to expand access. These include:

• Mainstreaming addiction education: Rather than the 8-hour training the Drug Enforcement Administration is now requiring of all clinicians who prescribe controlled substances, incorporate education about addiction during medical school, residency, and other training programs.
• Expanding methadone access: Rethinking methadone regulations, including transitioning stable patients to office-based care with general practitioners.
• Investing in the addiction treatment workforce: Federally fund training programs, including addiction medicine fellowship programs for physicians and training in addiction programs for nurse practitioners, social workers, and mental health counselors.

“The X waiver was one example of an onerous and unnecessary barrier to a lifesaving intervention, but there are many others, including methadone regulations and policies obstructing access to harm-reduction services,” said Wakeman. “We believe the federal government should continue its important progress in expanding access to medication for substance use disorder by rethinking methadone regulations.”

Paper cited: Wakeman SE “Beyond the X — Next Steps in Policy Reforms to Address the Overdose Crisis” NEJM DOI: 10.1056/NEJMp2301479

About Mass General Brigham

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Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services. 

Mass General Brigham is a non-profit organization that is committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations and a principal teaching affiliate of Harvard Medical School. For more information, please visit massgeneralbrigham.org.