Faculty Bibliography

INTRODUCTION/BACKGROUND:We examined data from a large, high acuity, pediatric psychiatric emergency department (ED) to assess both the immediate and longer-term impact of the pandemic on ED visits for suicidal thoughts and behaviors (STBs) among youth. METHODS:Youth ages 5-17 years presenting at a pediatric psychiatric ED in New York, NY from March 2019-November 2021 were included in this study. Visits were categorized as pre-pandemic, pandemic year 1, or pandemic year 2. We examined changes in demographic and clinical characteristics among patients presenting across the three time periods, as well as multivariable associations between these characteristics and STBs. RESULTS:Over 32 months, 2728 patients presented at 4161 visits. The prevalence of a discharge diagnosis of STBs increased from 21.2% pre-pandemic to 26.3% (p < 0.001) during pandemic year 1, and further increased to 30.1% (p = 0.049) during pandemic year 2. Youth were 21% more likely to receive a discharge diagnosis of STBs in pandemic year 1 (RR 1.21, 95% CI 1.07, 1.36) and 35% more likely in pandemic year 2 (RR 1.35, 95% CI 1.19, 1.52) compared to pre-pandemic baseline. CONCLUSIONS:In a large, high-acuity ED, STBs continued to increase 20 months after the initial COVID-19 lockdown. These findings highlight the persistent detrimental impact of the pandemic on youth mental health.

The e-cigarette (EC) epidemic began in the United States (US) in 2007; since 2014 EC is the most commonly used form of tobacco. However, the mental health implications of vaping are grossly unknown. The aim of this umbrella review is to provide astate-of-the-art summary of existing research concerning vaping and mental health conditions in children. Following the PRISMA Statement 2020 guidelines, a systematic search was conducted across PubMed, Cochrane Library, and Google Scholar up to April 15th, 2022 to locate relevant studies. The Joana Briggs Institute (JBI) methodology for umbrella reviews and quality appraisal tool was utilized. Six studies, pooling a total of 846,510 adolescents aged 21 years or below, were included by collating 85 primary clinical studies. Of these, 58.8% of the primary clinical studies originated in the US, with 4.7% from Canada, South Korea, and the United Kingdom each; 3.5% each from England and Taiwan; 2.4% each from Australia, France, Hawaii, Mexico, and Russia; and 1.2% each from Denmark, Greece, Hong Kong, Iceland, New Zealand, Poland, and Switzerland. Overall, significant associations were found between mental health outcomes, including depression and suicidality, among current EC users and those who had ever used EC. Compared to adolescents who had never used EC, both depression and anxiety were reportedly higher among EC users. Impulsive behaviors, reported as impulsivity, were also found to be correlated with the adoption of EC use. However, there is a lack of evidence regarding the impact of EC use on mental health outcomes in children. This umbrella review highlights the urgent need to further explore the effects of current EC use from a psychiatric and public health perspective.

OBJECTIVE:The increasingly widespread use of kratom in the United States has raised concerns about its safety as well as spurring research into potential applications of its active ingredients in medical treatments. METHODS:We reviewed the literature published over the past 20 years, including peer-reviewed publications and data released by United States government health agencies to provide an overview of this topic. RESULTS:A variety of potentially beneficial and adverse effects of kratom use related to its opioid and stimulant properties have been documented, including addiction and withdrawal. Preliminary research in animals and case reports in humans have suggested medical utility for kratom in treating alcohol and opioid use disorders, pain, depression, and anxiety. However, the lack of controlled, standardized studies limits the clinical utility of this agent and is a barrier to safe consumption. CONCLUSIONS:Historically, kratom has been used for medical purposes and for the treatment of alcohol and substance use disorders. The currently available literature suggests a potential for similar clinical applications. However, without controlled research studies or regulation, kratom poses numerous health risks to consumers.

Background and Objectives/UNASSIGNED:Here we aimed to characterize clinical outcomes in those receiving treatment at a Veterans Health Administration (VHA) methadone maintenance treatment program (MMT) during the COVID 19 pandemic in which SAMSHA regulations for MMTs were changed to provide a greater number of methadone allotments and decreased clinic-visit frequency. Methods/UNASSIGNED:We report results of a single-site, pre-post cohort study of urine drug screen data 3 months before and after an increase in allotments of take-home medication from the methadone clinic. One hundred twenty-nine patients met inclusion criteria for this study. The study was reviewed by the NYHHS IRB committee and granted final approval by the Research and Development Committee. Results/UNASSIGNED: > .05), number of new medical illnesses or overdoses. We controlled for participant age, substance use disorder diagnosis, psychiatric disorder diagnosis, and number of years in treatment. Discussion/Conclusions/UNASSIGNED:The results of the study illustrate the relative safety of the changes made at this particular MMT during the pandemic. Additionally, there was continued adherence to methadone treatment with minimal change in illicit substance use during period 1 and period 2. Scientific Significance/UNASSIGNED:To these authors' knowledge this paper is one of the first to examine clinical outcomes in those with opioid addiction prescribed methadone from MMTs during the COVID 19 pandemic.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Prescription Drug Monitoring Programs (PDMP) detect high-risk prescribing and patient behaviors. This study describes the characteristics associated with documented PDMP access when prescribing opioids. METHODS:Retrospective chart review of 695 opioid prescriptions written from inpatient and outpatient medical and psychiatric settings. Data were abstracted and analyzed to identify characteristics associated with documented PDMP access. RESULTS:One-third of the charts had PDMP access documented within the week of opioid prescription; 12% showed PDMP consultation on the same day. Services varied greatly from 10.5% (inpatient medicine) to 57% (inpatient psychiatry) with regard to same-day PDMP access (P < .0001). Patient characteristics associated with PDMP access include having acute pain, current mental health treatment, and current and past substance use disorders (all P < .05). Logistic regression modeling identified three variables associated with the odds of PDMP access (c-statistic = 0.66): if the prescription originated from the inpatient medicine unit (odds ratio [OR] = 0.47, 95% confidence interval [CI] = 0.32, 0.68), or if the patient received a prescription for an opioid in the past 30 days (OR = 0.30, 95% CI = 0.10, 0.90) or had a urine toxicology screen in the past year (OR = 2.00, 95% CI = 1.40, 2.90). DISCUSSION AND CONCLUSIONS/CONCLUSIONS:Utilization of the PDMP varied by specialty and setting. SCIENTIFIC SIGNIFICANCE/CONCLUSIONS:This study is among the first to compare rates of PDMP access in a large sample by specialty and practice setting in a healthcare system with a policy requiring its access and appropriate documentation. With less than one-third adherence to the policy, additional steps to increase consistent PDMP access are warranted. (Am J Addict 2021;00:00-00).

Maintaining patient safety and continuity of care is of the utmost importance in methadone treatment. However, many patients face considerable barriers for entry into methadone maintenance therapy (MMT). The pre-COVID19 requirements for patients enrolled in methadone treatment may pose an additional such barrier to patients with work or travel obligations. Therefore, it is imperative that federal methadone policy strike an appropriate balance between the interests of patient retention and safety and the interests of access to care. These considerations are particularly important in the context of current and future infectious diseases outbreaks or other crises. The necessity of strict methadone policies for opioid use disorder should continue to be explored with further research studies. XXBackground(s): To facilitate social distancing during the COVID- 19 pandemic, Substance Abuse and Mental Health Services Administration (SAMHSA) has permitted clinicians discretion to prescribe up to 28 days of take-home methadone doses to patients in opioid treatment programs (OTPs) regardless of patients' duration of prior treatment. Previously, the United States had long maintained take-home restrictions aimed at preventing overdose and diversion, but the effectiveness of these restrictions and of supervised consumption of methadone overall have been poorly studied. XXObjective(s): Determine the effects of early access to takehome doses on treatment retention in MMT. Examine the risk of overdose given early access to take-home methadone doses. Characterize the effectiveness of implementation of emergency methadone policies in the context of a public health crisis. XXMethod(s): Following the SAMHSA restriction changes, in March 2020 the OTP at the Veterans Affairs New York Harbor Health System in Manhattan suspended new patient enrollment and offered current patients between 4 and 28 days of take-home methadone, based on clinician assessment of patient risk. The proposed study will perform a retrospective chart review comparing the rates of patient dropout and illicit drug overdose in the 3 months prior to these changes to the rates in the 3 months following. XXResult(s): Results are forthcoming pending IRB approval. XXConclusion(s): Conclusions are forthcoming pending IRB approval. Scientific Significance: This will be the first study of its kind to examine changes in SAMHSA's take-home methadone schedule and patient outcomes in times of crisis. Of note, New York City OTPs and their patients have struggled to maintain continuity of care during other states of emergency, such as 9/11 and Hurricane Sandy. Thus, the results may further inform the approach to regulatory oversight of methadone prescription during states of disaster