Monday, August 3, 2020

CBD May Help Patients With Cannabis Use Disorder Reduce Use

Cannabidiol (CBD) may be helpful at reducing cannabis use in people with cannabis use disorder, according to a report in Lancet Psychiatry. Study participants who took 400 mg or 800 mg of CBD daily for four weeks reported more days of cannabis abstinence than those who took placebo.

“[O]ur trial provides the first causal evidence supporting cannabidiol as a treatment for cannabis use disorders,” wrote Tom Freeman, Ph.D., of the University of Bath and colleagues. “These findings are important in light of major policy changes surrounding the production and sale of cannabis products, increases in the number of people entering treatment for cannabis use disorders worldwide, and the absence of recommended pharmacotherapies at present.”

Freeman and colleagues recruited individuals aged 16 to 60 who had cannabis use disorder of at least moderate severity (four or more of the DSM-5 diagnostic criteria) and expressed a desire to quit using cannabis for a two-stage adaptive study.

In the first stage, 48 participants were randomly assigned to receive CBD (200 mg, 400 mg, or 800 mg) or placebo daily for four weeks. All participants also received six 30-minute, individual motivational interviewing sessions during this time. 

After four weeks, the investigators conducted an interim analysis and concluded that while 400 mg and 800 mg CBD were more effective than placebo at reducing cannabis use, 200 mg CBD was not more effective than placebo. The investigators then enrolled 34 more participants who received four weeks of placebo, 400 mg CBD, or 800 mg CBD. Seventy-seven (94%) of 82 participants completed treatment. The final analysis included data from 23 people who took placebo, 24 who took 400 mg CBD, and 23 who took 800 mg CBD.

Freeman and colleagues found that both doses of CBD were more effective than placebo at reducing cannabis use, with the 400 mg dose being slightly more effective. Compared with placebo, participants who took 400 mg or 800 mg CBD used cannabis 0.48 and 0.27 fewer days a week, respectively. Urine tests also confirmed lower levels of cannabis metabolites in people taking the CBD. CBD was well tolerated and produced no serious side effects.

“It is important to be aware that this dose range (400 mg to 800 mg) is considerably higher than concentrations found in cannabidiol products widely available without a prescription,” Freeman and colleagues cautioned. “These products have inadequate quality assurance and should not be used for medicinal purposes.”

For related information, see the Psychiatric News article “Medications May Ease Cannabis Withdrawal But Fail to Achieve Abstinence.”

(Image: iStock/Nastco)

Please Take a Few Moments to Complete APA Survey on Racism

The APA Presidential Task Force to Address Structural Racism Throughout Psychiatry invites you to complete the second in a series of surveys on how racism impacts the field of psychiatry. Your answers will be anonymous. They will be used to inform the Task Force’s work and may be anonymously cited in future work. The survey is open from July 23 to August 6.

Friday, July 31, 2020

House Passes $1.3 Trillion Spending Package, Including Funding for Major MH Initiatives

APA Urges Senate Action

Today the U.S. House of Representatives approved $96.4 billion in funding for the Department of Health and Human Services by passing the Labor-Health and Human Services-Education FY 2021 appropriations bill. The bill is part of HR 7617, a $1.3 trillion spending package that funds most federal agencies throughout the next fiscal year.

The bill includes $6 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA) for programs related to mental health and substance use, an increase of more than $100 million over the previous fiscal year. The impact of APA’s advocacy was evident in this increase, as the organization’s work with mental health partners resulted in a $35 million increase to the SAMHSA budget to improve mental health crisis systems and suicide prevention at the state and local levels, including $25 million for a national suicide prevention lifeline.

The bill also includes the following:
  • $8 billion for the Centers for Disease Control and Prevention (CDC), an increase of over $250 million from the previous fiscal year.
  • $66.95 million for the CDC Racial and Ethnic Approaches to Community Health (REACH) program, a 14% increase in funding for the Minority Fellowship Program (MFP), and a request that the National Institute of Mental Health develop a 10-year strategic plan to eliminate racial mental health disparities in youth by 2030.
  • Funds for firearm injury and mortality prevention research: $30 million for the CDC and $25 million for the National Institutes of Health.
  • An increase of over 40% in funding for the loan repayment program for the Substance Use Disorder Treatment Workforce Program through the Health Resources and Services Administration.
  • $550 million for the National Institute on Alcohol Abuse and Alcoholism, $1.47 billion for the National Institute on Drug Abuse, and $2.06 billion for the National Institute of Mental Health, all of which represent increases from the previous fiscal year.
“We applaud the House for recognizing the critical need for funding for mental health, particularly the increased funding for suicide prevention and to address racial disparities in mental health care,” said APA President Jeffrey Geller, M.D., M.P.H., in a statement released by APA this afternoon. “The nation is struggling with a raging COVID-19 pandemic, the continued rise in suicides, racial inequities in health care, and the continued opioid epidemic—all reasons why a boost in federal funding is essential. We need a steady, long-term commitment by Congress to address these critical issues.”

APA CEO and Medical Director Saul Levin, M.D., M.P.A., added, “APA urges the Senate to support and build upon these investments to our nation’s mental health. Our members and our organization stand ready to work with members on both sides of the aisle on a sustained effort to better fund our nation’s mental health care needs.”

Please Take a Few Moments to Complete APA Survey on Racism

The APA Presidential Task Force to Address Structural Racism Throughout Psychiatry invites you to complete the second in a series of surveys on how racism impacts the field of psychiatry. Your answers will be anonymous. They will be used to inform the Task Force’s work and may be anonymously cited in future work. The survey is open from July 23 to August 6.

Thursday, July 30, 2020

APA Mourns Loss of Rep. John Lewis, Praises Trailblazing Legacy

As civil rights leader and longtime congressman Rep. John Lewis is laid to rest today in Atlanta, APA released a statement honoring his memory and celebrating his lifelong work to end racial inequality.

“We are mourning the loss of a leader who meant so much to the Black community and to all Americans who strive for equity and justice,” said APA President Jeffrey Geller, M.D., M.P.H., in APA’s statement. “For more than a half century, Rep. John Lewis showed what walking the walk truly means in promoting civil rights, even putting his own life at risk in service of the cause. His lesson to us is to continue that work through speaking up, taking tangible actions, exhibiting humility, and practicing perseverance. In taking on racial discrimination, we will do well if we take to heart his words: ‘I believe race is too heavy a burden to carry into the 21st century. It's time to lay it down. We all came here in different ships, but now we're all in the same boat.’”

Lewis began advocating for racial equality when he was just a teenager. At 23, he was the youngest speaker at the March on Washington in 1963, at which the Rev. Martin Luther King Jr., gave his iconic, “I Have a Dream,” speech. Lewis was also one of the original Freedom Riders, civil rights activists who rode buses between Southern states to challenge seating segregation.

In 1965, when Lewis was 25, he helped lead a march for voting rights across the Edmund Pettus Bridge in Selma, Ala. Alabama state troopers met the marchers at the end of the bridge and charged them when they stopped to pray. Lewis’s skull was fractured during the incident that day, which has since been dubbed “Bloody Sunday.”

As a member of Congress, Lewis was dedicated to advancing racial and ethnic equality and supported policies that ensured struggling families had access to safety nets. Just this year he had introduced legislation aimed at supporting the health and well-being of current and former foster care youth transitioning into adulthood (HR 7591), as well as a bill that would ensure minority and medically underserved communities have access to public health interventions and medically necessary services during the COVID-19 pandemic (HR 7546).

“Rep. John Lewis was a selfless, constant advocate for civil rights for Black Americans and other underrepresented groups and a shining example for the rest of all of us,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A., in APA’s statement. “Rep. Lewis continually made his voice heard and pushed for change to help millions of Americans, whether it was during the struggle for voting rights or in fierce advocacy for the Affordable Care Act. His memory serves as an inspiration to us at APA to continue his legacy and to strive for the ideals he believed in.”

Lewis also cosponsored the George Floyd Justice in Policing Act (HR 7120), which includes a wide variety of policies meant to increase accountability among law enforcement and end discriminatory policing practices. In a floor statement Lewis made in support of the legislation, he said that, in making the call for racial equity and equality, young people today are “taking up the mantle in a movement that I know all too well.

“For far too long, equal justice and protection under the law have been deferred dreams for Black people and communities of color across our country,” Lewis said in his floor statement. “[A] democracy cannot thrive where power remains unchecked and justice is reserved for a select few. Ignoring these cries and failing to respond to this movement is simply not an option. For peace cannot exist where justice is not served.”

Wednesday, July 29, 2020

Medicare Data Show Disproportionate Effect of COVID-19 on Racial, Ethnic Minorities

Among Medicare beneficiaries, racial minorities—African Americans, Hispanics, and American Indians/Alaskan Natives—have been disproportionately affected by the global COVID-19 pandemic compared with white beneficiaries, according to a “Preliminary Medicare COVID-19 Snapshot” released this week by the Centers for Medicare and Medicaid Services (CMS).

The report was based on claims data from the Medicare Fee-for-Service (FFS) and Medicare Advantage programs received by July 17. COVID-19 cases were determined by an ICD-10 diagnosis code for COVID-19 on a claim or encounter record for any health care setting—for example, physician’s office, inpatient hospital, or laboratory.

According to the report, 549,414 Medicare beneficiaries were diagnosed with COVID-19 between January 1 and June 20. The CMS update reported the following trends about minority groups within the Medicare population:

  • Black beneficiaries have been most severely affected by the pandemic, with 1,658 cases of COVID-19 per 100,000 beneficiaries and 670 COVID-19 hospitalizations per 100,000 beneficiaries.
  • Among Hispanic beneficiaries, there have been 1,230 cases of COVID-19 and 401 COVID-19 hospitalizations per 100,000 beneficiaries.
  • Among American Indian/Alaskan Native beneficiaries, there have been 1,125 cases of COVID-19 and 505 COVID-19 hospitalizations per 100,000 beneficiaries.

Dual Medicare and Medicaid beneficiaries and those with kidney disease have also been especially hard hit by the pandemic. Dual beneficiaries—who often have multiple chronic conditions (including mental and substance use disorders) and are typically in lower socioeconomic groups—have experienced 2,310 COVID-19 cases per 100,000 beneficiaries and 719 hospitalizations per 100,000 beneficiaries.

A total of 5,781 Medicare beneficiaries with end-stage renal disease per 100,000 beneficiaries have been diagnosed with COVID-19, and 1,911 have been hospitalized.

Tuesday, July 28, 2020

Lessons From Pandemic Could Advance Understanding of How Best to Support Vulnerable Families

The trauma and unpredictability of COVID-19 are likely to add stress in the lives of vulnerable children, including those who are abused, maltreated, and/or have a mental illness. There is much that can be learned from such stress to help vulnerable families in the future, according to an article published Monday in JAMA Pediatrics.

“Recent advancements across disciplines relevant to early child development (for example, pediatrics, neuroscience, epigenetics, psychology, and public health) can be used to understand the consequences of this pandemic and develop and scale empirically supported interventions for adversity-exposed children and families,” wrote Danielle Roubinov, Ph.D., Nicole R. Bush, Ph.D., and W. Thomas Boyce, M.D., of the University of California, San Francisco.

To understand the consequences of COVID-19 on child development, the authors advised researchers to carefully assess parents and children over time about family exposure to the pandemic and COVID-19–associated losses/strains, including the loss of housing, increased family conflict, and/or separation from a parent or the death of loved one. Collecting information about the mental health of parents and children and family access to supports are also essential for evaluating children’s response to the pandemic, they added.

The authors also recommended that researchers studying the consequences of COVID-19 on vulnerable families consider the following:

  • Examine factors that promote resilience and positive adjustment.
  • Assess biological markers of resiliency or recovery.
  • Consider how best to analyze factors that mediate or moderate the association of the pandemic with parent, child, and overall family functioning.
  • Collect data on health disparities.
  • Evaluate ongoing efforts to meet COVID-associated mental health needs and other prevention and intervention efforts that have continued despite pandemic.

“[L]essons from COVID-19 have the potential to deepen rather than diminish the research agenda on adverse early experiences among children and families. The current global pandemic is an international tragedy; however, the greatest burden of morbidity, mortality, and misfortune will be borne by those with the fewest resources,” Roubinov, Bush, and Boyce concluded. “Our purpose is not to turn this tragedy into academic gain but rather to promote advancement in the science of child development as a means to reduce the chasm between advantaged and vulnerable families.”

(Image: iStock/PeopleImages)

Have You Thought About Running for APA Office? Help Steer APA’s Future
Nominate yourself or a colleague

As chair of APA’s Nominating Committee, Immediate Past President Bruce Schwartz, M.D., is seeking to diversify the elected leadership of APA and invites all members to consider running for one of the open Board of Trustee offices in APA’s 2021 election: president-elect; secretary; early-career psychiatrist trustee-at-large; minority/underrepresented representative trustee; Area 1, 4, and 7 trustees; and resident-fellow member trustee-elect. You may nominate yourself or a colleague—the important point is that you get involved! The deadline is Tuesday, September 1.

Access Nomination Requirements and Form

(Image: iStock/IIIerlok_Xolms)

Monday, July 27, 2020

HHS Renews Declaration of Public Health Emergency for COVID-19

Last week, U.S. Secretary of Health and Human Services (HHS) Alex Azar formally renewed the agency’s determination that the COVID-19 pandemic is a public health emergency. The extension of this public health emergency keeps many regulatory changes and waivers relevant to psychiatrists—such as relaxed telemedicine restrictions—in effect for the time being.

Secretary Azar first declared COVID-19 a public health emergency in late January and subsequently renewed that status on April 21. APA and other health organizations had urged the Trump administration to authorize another extension to help combat the ongoing COVID-19 pandemic. There have been over 4 million cases of COVID-19 and nearly 150,000 COVID-related deaths since the virus was first identified in the United States on January 20.

“APA recently surveyed its membership to understand the impact of easing telehealth regulations on practice during the PHE [public health emergency]. The survey found a major shift to the use of telehealth after the PHE was declared,” wrote APA CEO and Medical Director Saul Levin, M.D., M.P.A., in a letter to the HHS secretary. “While the changes were necessary to comply with physical distancing and self-isolation mandates, this shows that telehealth for treating psychiatric and substance use disorders can be adopted quickly, and efficiently, and that most barriers to doing so in the first place may have been regulatory in nature. These survey results mirror national research on telehealth that show improved access to care, reduced no-show rates, and a high rate of patient satisfaction.”

In addition to maintaining relaxed telemedicine guidelines, the continuation of the emergency determination allows the Food and Drug Administration to quickly authorize the use of unapproved COVID-19 medications for patients and provides state and local health departments more flexibility to reassign some emergency personnel to respond to virus outbreaks.

As stipulated by law, the emergency extension—which began July 25—is valid for 90 days and thus due to expire at the end of October.

Please Take a Few Moments to Complete APA Survey on Racism

The APA Presidential Task Force to Address Structural Racism Throughout Psychiatry invites you to complete the second in a series of surveys on how racism impacts the field of psychiatry. Your answers will be anonymous. They will be used to inform the Task Force’s work and may be anonymously cited in future work. This survey is open from July 23 to August 6.

Friday, July 24, 2020

Psychiatrists Still Not Reimbursed on Par With Primary Care Physicians

Medicaid often reimburses psychiatrists less than primary care physicians for treating mental or substance use disorders, according to a report published today in Psychiatric Services in Advance. This disparity in reimbursement may explain why psychiatrists are less likely to participate in Medicaid than primary care physicians and why some regions face a shortage of psychiatrists, the researchers wrote.

Tami L. Mark, Ph.D., M.B.A., and colleagues analyzed data from outpatient medical claims from 2014 for 11 states. The claims were for a primary behavioral health diagnosis such as a mental or substance use disorder and included evaluation and management procedure codes of 99213 (established patient office visit, low to moderate severity) or 99214 (established patient office visit, moderate severity). The states included were Georgia, Idaho, Michigan, Minnesota, Mississippi, New Jersey, Pennsylvania, South Dakota, Vermont, West Virginia, and Wyoming.

Primary care physicians were reimbursed more than psychiatrists for code 99213 in 10 of the states and for code 99214 in nine of the states. Primary care physicians were reimbursed $1 to $34 more than psychiatrists for code 99213 and $5 to $40 more for code 99214.

“The disparity in reimbursement rates between psychiatrists and primary care physicians is inconsistent with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which requires that provider reimbursement rates for treating mental and substance use disorders be based on criteria that are comparable to the criteria for setting reimbursement rates for medical providers and applied no more stringently,” the researchers wrote. However, although MHPAEA applied to Medicaid managed care plans and the Children's Health Insurance Program as of 2009, these health programs had until 2017 to comply, the researchers noted.

“A key implication of these findings is that reducing reimbursement disparities between psychiatrists and other medical doctors may increase the supply of psychiatrists willing to treat Medicaid patients,” the researchers wrote.

(Image: iStock/utah778)

HHS Extends COVID-19 Public Health Emergency

Health and Human Services Secretary Alex Azar on Thursday extended for an additional 90 days the current COVID-19 public health emergency, which was set to expire on July 25. APA has heard from many members expressing concern about the impending deadline and the implication for various regulatory waivers implemented because of the pandemic, including those pertaining to telemedicine.


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