Leah Kuntz

The National Commission on Correctional Health Care (NCCHC) and 166 national organizations recently signed a letter to Senate leadership advocating for increased access to buprenorphine, an FDA-approved medication for opioid use disorder (OUD). They urged US Senate to pass the bipartisan 

Mainstreaming Addiction Treatment (MAT) Act

“In the midst of a deadly and accelerating overdose crisis, the MAT Act is a common-sense solution that will prevent overdoses, increase access to treatment, and reduce stigma,” the letter reads.

, along with methadone and extended-release naltrexone, is 1 of 3 medications currently approved by the US Food and Drug Administration (FDA) to treat OUD and is considered the “gold standard” treatment. It also keeps individuals with OUD from returning to illicit drug use—and to jail.

 severely hinders access to buprenorphine by preventing health care providers from prescribing it. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), only about 1 in 10 people with OUD receive medications for the condition because of the X-waiver. Furthermore, the Department of Health and Human Services claims that fully 40% of US counties do not have any health care providers who can prescribe buprenorphine.

If passed, the MAT Act will eliminate the X-waiver and make buprenorphine more available and accessible for Americans with OUD.

The letter was sent to Majority Leader Chuck Schumer, Minority Leader Mitch McConnell, Chair Patty Murray, and Ranking Member Richard Burr on August 31, Overdose Awareness Day. The letter can be found 

1. NCCHC Supports Access to MOUD. National Commission on Correctional Health Care. September 9, 2022. Accessed September 21, 2022. 

https://www.ncchc.org/ncchc-supports-access-to-moud/

2. The Mainstreaming Addiction Treatment Act (“MAT Act”, S. 445 / H.R. 1384). August 31, 2022. Accessed September 21, 2022. 

https://static1.squarespace.com/static/5eb15fa07d53aa0e85b448d7/t/6317704dfeb1183bfc5ada54/1662480461791/MAT+Act+(S+445)+-+167+Organizations+Submit+Letter+to+Senate+Leadership+Urging+Passage+with+Sept.+CR+(Aug22).pdf

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The NCCHC and 166 national organizations recently signed a letter to Senate leadership advocating for increased access to buprenorphine. 

Advocating for Medication for Opioid Use Disorder

The US Preventive Services Task Force (USPSTF) just released a draft recommendation stating that adults under the age of 65 should be screened for anxiety. The USPSTF draft recommendation is not final; it will now enter a public comment period.

The USPSTF draft “concludes with moderate certainty that screening for anxiety in adults, including pregnant and postpartum persons, has a moderate net benefit,” although the evidence for older adults (65 and older) is insufficient. The USPSTF has not previously made a recommendation on this topic.

Prominent risk factors for anxiety disorders include sociodemographic factors, such as female sex, African American race, or poverty; psychosocial factors, like traumatic life events or substance use; and physical and mental health factors, like other psychiatric conditions or family history of mental disorders.

The draft also recommends screening for major depressive disorder in adults, which remains consistent with previous 2016 recommendations for depression screening.

1. Draft recommendation statement: screening for anxiety in adults. US Preventative Services Task Force. September 20, 2022. 

https://uspreventiveservicestaskforce.org/uspstf/draft-recommendation/anxiety-adults-screening#citation1

For the first time, the USPSTF is recommending anxiety screening for adults under 65. 

USPSTF Makes Historic Anxiety and Depression Draft Screening Recommendations 

Can reading an online story a day by someone with lived experience managing suicidal thoughts reduce your patient’s suicidal thoughts and behaviors? New research says yes.

Investigators at Montefiore-Einstein, Harvard University, and The Mighty—an online community that connects people facing health challenges—challenged the notion that social media is harmful to mental health with their findings, 

“Digital Bibliotherapy as a Scalable Intervention for Suicidal Thoughts: A Randomized Controlled Trial,”

Journal of Consulting and Clinical Psychology

 In a randomized-controlled trial of digital bibliotherapy, investigators found evidence that social connection and shared experience had potential in lowering suicidal thoughts.

“What we’ve learned gives us a new line of attack in this long-standing public health crisis: an easy way to address key psychological factors, such as loneliness and hopelessness, that lead people to think about ending their lives,” said study lead Peter J. Franz, PhD, of Montefiore Medical Center. “It takes 10 minutes or less each day to read a story, yet digital narrative-based bibliotherapy makes a measurable difference, which may have a protective effect against suicidal thoughts and behaviors. This could be layered into complementary therapies. And it’s as highly scalable as the internet, able to reach millions of people simply and cost-effectively.”

Bibliotherapy is defined as “a therapeutic approach in which a planned reading program facilitates the recovery of patients living with mental illness or emotional disturbance.”

The study involved 528 participants who were randomized to a treatment condition (

=266), in which they read 1 suicide narrative per day for 14 days, or to a waitlist control condition (

=262). The desire to commit suicide was assessed daily for the 14-day trial period and for 2 weeks after. Participants who received the bibliotherapy intervention reported modest but statistically significantly lower suicidal thoughts and behaviors. These benefits were explained in part by higher feelings of shared experience and optimism among those who read the stories.

Results were also highly repeatable. Members of the control group were subsequently offered bibliotherapy, and they also reported a significantly lower desire to commit suicide. Furthermore, participants who read narratives daily had less suicidal thoughts and behaviors than those who read sporadically.

“Bibliotherapy is well-established as a way to treat psychological distress, but this was the first randomized-controlled trial of digital narrative-based bibliotherapy for those struggling with suicidal thoughts and behaviors—and the first using content generated organically by users,” said Matt Nock, PhD, Chair of Harvard’s department of psychology. “This is a potentially important piece in the suicide-prevention puzzle. And, because mental health impacts overall health and vice-versa, these findings may be useful in addressing a broad range of conditions, particularly those involving feelings of isolation or hard-to-discuss subject matter.”

Although this research shows the power of reading stories online in helping people with suicidal thoughts and behaviors, future research could explore if this approach is effective in addressing other health issues shaped by similar factors.

“This study validates our belief that when people get the support and information they need, they’re better equipped to help improve health outcomes,” said Mike Porath, founder and CEO of The Mighty. “But it also signals where we go from here: If feelings of shared experience and optimism work for people with suicidal thoughts and behaviors, then digital bibliotherapy also may work for people with chronic pain, issues particularly relevant to the LGBTQIA+ community or any health challenge where isolation, stigma or the need for interaction are factors.This is only the beginning, and the possibilities are exciting.”

Digital bibliotherapy as a scalable intervention for suicidal thoughts: a randomized controlled trial.

2. Bibliotherapy. American Library Association. Accessed September 20, 2022. 

https://www.ala.org/tools/atoz/bibliotherapy

Reading 1 story a day might help those living with suicidal thoughts and behaviors. 

Reading First-Hand Stories May Help Reduce Suicidal Thoughts

The US Food and Drug Administration (FDA) has accepted the New Drug Application (NDA) for aripiprazole 2-month, ready-to-use, long-acting injectable, a medication administered for the treatment of schizophrenia in adults and for maintenance monotherapy treatment of bipolar I disorder in adults. It is intended for dosing every 2 months via intramuscular injection in the gluteal muscle.

If approved, it would be the first 2-month LAI antipsychotic indicated for both the treatment of schizophrenia and the maintenance treatment of bipolar I disorder in the United States.

“This is an important milestone in our efforts to offer adult patients with schizophrenia or bipolar I disorder a new option designed to support treatment goals and offer greater flexibility. The trial results reinforce the long-standing efficacy and safety profile of the once-monthly aripiprazole long-acting injectable,” said Johan Luthman, executive vice president, Lundbeck Research & Development.

The 2-month long-acting injectable of aripiprazole in 960 mg and 720 mg prefilled syringes will deliver sustained plasma concentrations similar to that demonstrated in studies with aripiprazole once-monthly long-acting injectable.

“Stability is critical for patients with schizophrenia and bipolar I – which means delaying time to relapse or recurrence and supporting their role as functioning members of their community,” said Robert McQuade, PhD, executive vice president and chief strategy officer of Otsuka Pharmaceutical Development & Commercialization. “As we continue our efforts to bring aripiprazole 2-month to market, we remain committed to our patients and confident that the favorable safety and tolerability profile will be clearly visible.”

The FDA target date for review completion is April 27, 2023.

Visit psychiatrictimes.com regularly for more updates and breaking news.

1. Otsuka and Lundbeck Announce U.S. FDA acceptance of new drug application for aripiprazole 2-month, ready-to-use, long-acting injectable to treat schizophrenia and bipolar I disorder in adults. News release. Business Wire. September 13, 2022. 

https://www.businesswire.com/news/home/20220913005499/en/Otsuka-and-Lundbeck-Announce-U.S.-FDA-Acceptance-of-New-Drug-Application-for-Aripiprazole-2-month-Ready-to-Use-Long-acting-Injectable-to-Treat-Schizophrenia-and-Bipolar-I-Disorder-in-Adults

The FDA has accepted the NDA for aripiprazole 2-month, ready-to-use, long-acting injectable.

NDA for Long-Acting Injectable for Schizophrenia and Bipolar I Accepted

When used as clinically indicated at the appropriate doses, stimulants are safe and effective for the treatment of 

 (ADHD); however, misuse may lead to serious adverse effects, including medication-induced persistent psychotic disorder. A case report published in 

found that the long-acting injectable haloperidol decanoate may be able to improve compliance and prognosis in patients with ADHD.

As described by Desai et al, long-acting injectable haloperidol decanoate—although not FDA approved for the treatment of stimulant-induced psychosis—was successfully used to treat a patient with stimulant-induced psychosis and a history of noncompliance with antipsychotic treatment.

In the case example, Desai et al describe “Mr X,” a 29-year-old Caucasian male who was brought to the emergency department (ED) for altered mental status. Mr X was found to be agitated, incoherent, and responding to internal stimuli when evaluated by emergency medical services. Mr X has a past psychiatric history of ADHD, anxiety disorder, and stimulant-induced psychosis, though there is no known psychiatric history in Mr X’s family. Mr X was diagnosed with ADHD as an adult, and was prescribed Adderall at the age of 19, taking a dosage of up to 90 mg per day. Mr X had been hospitalized before in an inpatient psychiatric unit for a similar symptomatic presentation that was attributed to Adderall use above the approved dosage. Previously, he was prescribed olanzapine and risperidone for 

, but was noncompliant with treatment. Following his last discharge from an inpatient unit, Mr X continued to obtain Adderall.

Following this inpatient admission, Mr X was started on oral risperidone 1 mg BID; however, he continued to refuse medications. Eventually, Mr X agreed to take oral Haldol 5 mg BID that was later up titrated to 7.5 mg BID. Throughout his inpatient stay, he continued to remain insistent on getting Adderall or Vyvanse for his ADHD without specifying dosage. Due to his 2 inpatient psychiatric hospitalizations in the past 6 months, his continuation of Adderall abuse, and noncompliance with prescribed antipsychotic treatment, clinicians offered Mr X long-acting Haldol. He was given 2 injections of Haldol Decanoate 50 mg and 100 mg intramuscularly. Additionally, Mr X was prescribed clonidine 0.1 mg daily for the management of his ADHD. Mr X tolerated the prescribed treatment without any adverse effects. His behaviors were reduced significantly, and he was safely discharged, where he remained compliant with the treatment plan for a follow-up period of 6 months.

“Long-acting Haldol provided a great response; however, further research is required to assess long-acting injectables as a definitive treatment for stimulant-induced psychotic disorders, especially in patients with a history of noncompliance and recurrent hospitalizations,” wrote the authors.

 might increase the risk of developing subsequent psychotic disorders during adulthood.

 Prolonged stimulant misuse might contribute to the development of a subsequent psychotic disorder in genetically susceptible individuals; more research is needed to determine. Overdiagnosis and treatment of ADHD, plus a rise in prescription stimulant misuse, might further complicate this relationship.

Amphetamines can mimic psychosis, especially when taken recreationally above approved doses. Acute amphetamine intoxication can present as a substance-induced psychotic disorder, although some individuals may go on to develop a psychotic disorder with onset during intoxication that continues. This poses an especially unique challenge in young adults, when separating first onset psychosis from a stimulant-induced psychotic disorder and subsequent transition to schizophrenia-like illness, can be difficult but is crucial for determining appropriate care.

Distinguishing First Onset Psychosis From Stimulant-Induced Psychosis

Some studies indicated there may be different symptom presentations in the case of amphetamine-induced persistent psychosis. Yang et al suggested that methamphetamine-induced psychosis presents with less 

 and negative symptoms compared with patients with primary schizophrenic psychosis.

Obvious predictors of amphetamine-induced psychosis include the dosage and duration of amphetamine use, but research has highlighted the additional role of gamma-aminobutyric acid (GABA) dysfunction resulting in a heightened risk of stimulant-induced psychosis. A study by Ahn et al suggested that preexisting GABA deficits increased vulnerability to stimulant-induced psychosis in healthy subjects.

Treatment of stimulant-induced psychosis may be similar to treatment of psychotic disorders and schizophrenia. For example, a recent systematic review by Fluyau et al found that aripiprazole (Abilify), haloperidol (Haldol), quetiapine (Seroquel), olanzapine (Zyprexa), and risperidone (Risperdal) were able to reduce or control stimulant-induced psychosis with similar efficacy.

 Additionally, a systematic review by Coles et al found long-acting injectable antipsychotics to be an effective treatment for dual diagnosis schizophrenia and substance use disorder.

Desai et al noted further research is needed to identify individuals that are at increased risk of developing persistent psychosis from stimulant abuse. They suggested that α2-adrenergic agonists may be a safer alternative for the management of ADHD in such cases.

Adderall-induced persistent psychotic disorder managed with long-acting injectable haloperidol decanoate.

2. Nourredine M, Gering A, Fourneret P, et al. 

Association of attention-deficit/hyperactivity disorder in childhood and adolescence with the risk of subsequent psychotic disorder: a systematic review and meta-analysis.

Methamphetamine-associated psychosis: links to drug use characteristics and similarity to primary psychosis.

Role of GABA deficit in sensitivity to the psychotomimetic effects of amphetamine.

Antipsychotics for amphetamine psychosis. A systematic review.

6. Coles AS, Knezevic D, George TP, et al. 

Long-acting injectable antipsychotic treatment in schizophrenia and co-occurring substance use disorders: a systematic review.

Long-acting injectable haloperidol decanoate may work as a treatment for Adderall-induced persistent psychosis. 

Stimulant-Induced Persistent Psychotic Disorder: New Treatment Potential  

A new study finds that mood shifts and exposure to alcohol-related cues contribute to alcohol cravings in opposite ways for men and women.

Investigators at the University of Central Florida explored how attention to alcohol-related cues and the influence of mood and biological sex affects current cravings, by gathering data from 69 college student drinkers aged 18 to 29 who did not have psychiatric disorder. Two-thirds were female and 91% were white. For up to 15 days, participants carried a digital tablet and assessed their current mood and drinking. Investigators gathered approximately 4010 assessments, which covered mood (eg, “How nervous/sad/joyful are you feeling right now?”) and alcohol craving (eg, “How strong is your urge to drink alcohol right now?”). Bias was assessed by a visual task with alcohol-related and nonalcohol-related stimuli.

Consistent with the affect regulation model, positive mood was associated with momentary alcohol cravings; however, the associations were opposite for men and women. In men, attention to alcohol cues and alcohol cravings became stronger when they experienced improved mood. In women, the association strengthened during mood declines. This is the first study to find such an association. This new data may add credit to the theory that women develop addiction-like behavioral traits more rapidly than men.

The study provides further evidence of sex differences in attention and alcohol cravings, and may be reflective of varying cognitive processing of attentional versus social cues in men and women. Interventions could potentially focus on shifting attention away from alcohol cues to reduce craving, though they may yield different results among men and women.

1. Moskal KR, Dvorak RD, Burr EK, et al. 

Attention bias and alcohol craving: differential effects via biological sex and mood.

2. Mood influences alcohol craving differently in men and women, pointing the way to alcohol use disorder treatments tailored by sex. Newswise. News release. August 24, 2022. 

https://www.newswise.com/articles/mood-influences-alcohol-craving-differently-in-men-and-women-pointing-the-way-to-alcohol-use-disorder-treatments-tailored-by-sex

A new study finds mood shifts and alcohol-related cues affect men and women differently in terms of alcohol cravings. 