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Pregnancy-Specific Alcohol Policies May Not Work Most of these pregnancy specific alcohol policies have no impact on infant injuries and morbidities. Alcohol and Pregnancy HealthDay News — Most pregnancy-specific alcohol policies are not associated with decreased odds of infant injuries or morbidities, according to a study published online Aug. 3 in JAMA Network Open. Sarah C.M. Roberts, Dr.P.H., from the University of California in San Francisco, and colleagues examined the association between state-level pregnancy-specific alcohol policies and infant morbidities and maltreatment. The analysis included data from 1.4 million U.S. birthing person (aged 25 to 50 years) and infant pairs (singleton birth between 2006 and 2019). Researchers found that the policies of Reporting Requirements for Assessment/Treatment and Mandatory Warning Signs were associated with increased odds of infant injuries but not morbidities. The only policy to lower the risk for infant injuries was Priority Treatment for Pregnant Women Only. There was an association seen between Civil Commitment and increased odds of infant injuries but decreased odds of infant morbidities. For Priority Treatment for Pregnant Women and Women With Children, increased odds were observed of both infant injuries and infant morbidities. The investigators found no association between Reporting Requirements for Child Protective Services, Reporting Requirements for Data, Child Abuse/Neglect, and Limits on Criminal Prosecution with infant injuries or morbidities. “Policy makers should not assume that pregnancy-specific alcohol policies improve infant health,” the authors write. Full Article

Marijuana and hallucinogen use, binge drinking reached record highs in middle-aged adults, survey finds The latest results of the Monitoring the Future (MTF) longitudinal survey show that American adults are consuming marijuana and hallucinogens, vaping, and binge drinking at historic levels. "In 2022, we are seeing that marijuana and hallucinogen use, and vaping of nicotine and marijuana, are higher than ever among young adults ages 19 to 30," said Megan Patrick, research professor and principal investigator of the MTF study. "In addition, midlife adults ages 35 to 50 have the highest level of binge drinking we have ever seen in that age group," she said in a statement. The survey, conducted annually since 1975 by the University of Michigan's Institute for Social Research in Ann Arbor, queries nationally representative samples of eighth, 10th, and 12th graders and then follows a subset through adulthood to come up with longitudinal data. It is funded by the National Institute on Drug Abuse (NIDA). The adult data for 2022 were gathered by online and paper surveys from April to October 2022 and included responses from some 10,000 individuals. Particpants were divided into two cohorts: those aged 19–30 years and those aged 35–50 years. About a third of the older age group reported using marijuana in the past year, an all-time high, up from 25% in 2021 and more than double the users in 2012 (13%). Of this group, 4% reported past-year hallucinogen use, also a record high and double the reported use in 2021. Alcohol use among adults aged 35–50 has gradually increased over the past decade. Of this group, 85% reported past-year drinking in 2022, up from 83% in 2012. Binge drinking — defined as having five or more drinks in a row in the past 2 weeks — has also been on the rise in the past decade. One third of older adults reported binge drinking in 2022. Binge drinking was highest among White (31.4%) and Hispanic (30.6%) midlife adults and was lower among Black (17.1%) midlife adults. Vaping among the older age cohort has remained at similar levels since first measured in 2019; 9% vaped marijuana in the past year, while 7% vaped nicotine. Marijuana Popular Among Younger Americans Marijuana use on the rise among young Americans: study "In 2022, marijuana use among young adults reached the highest levels ever recorded since the indices were first available in 1988," the study authors write. Both past-year and daily use hit record levels for the cohort of those aged 19–30. Forty-four percent reported past-year marijuana use, up from 28% in 2012. The highest levels of use were in those aged 27 to 28. One in five reported daily use, up from 6% a decade ago; almost 14% of 23- to 24-year-olds reported daily use. Past-year use of hallucinogens — including LSD, MDMA, mescaline, peyote, mushrooms or psilocybin, and PCP — was reported by 8% of this age group. Most of the increase was driven by use of hallucinogens other than LSD, which accounted for 7% of the reported use. Young adults also reported record levels of vaping marijuana, with 21% reporting past-year use and 14% reporting past-month use. Vaping of nicotine has doubled in prevalence since the survey started asking about it, from 14% for past-year use in 2017 to 24% in 2022. NIDA Director Nora Volkow, MD, noted in a statement that the survey results show that "substance use is not limited to teens and young adults," adding that "these data help us understand how people use drugs across the lifespan."

Gene Therapy Offers New Way to Fight Alcohol Use Disorder A type of gene therapy that reboots the brain's reward system could curb drinking in those with severe alcohol use disorder. Researchers from Oregon Health & Science University implanted the therapy directly into the brains of rhesus monkeys that had been conditioned to drink eight to 10 alcoholic drinks a day. A harmless virus that carried a specific gene was placed in the region of the brain that regulates dopamine, which provides feelings of reward and pleasure. "We wanted to see if we could normalize the dopamine in these motivational areas – if, indeed, motivation to overdrink or drink heavily would be mitigated," said study author Kathleen Grant, PhD, a professor and chief of the Division of Neuroscience at the university's Oregon National Primate Research Center. Alcoholism research at OHSU advances with new $2.4 million federal grant The need for new alcohol use disorder treatments may be more dire than ever. Alcohol-related deaths in the United States increased dramatically between 2007 and 2020, especially in women, according to research published in the journal JAMA Network Open. The next year, they spiked again, to 108,791 alcohol-related deaths in 2021 alone, according to the National Institutes of Health. That's slightly more than the number of drug overdoses recorded in 2021. For the 29.5 million Americans with alcohol use disorder, also known as alcohol abuse or dependence, the road to recovery can be challenging. One reason is that the reward systems in their brains are working against them. At the first taste of alcohol, your body releases the feel-good brain chemical dopamine. But if you drink too much for too long, your brain reduces dopamine production, and you want even more alcohol to feel good again. The gene researchers placed in the monkeys' brains is called glial derived neurotrophic factor. It is a "growth factor," meaning it stimulates cells to multiply. It may help improve function of brain cells that synthesize dopamine, effectively resetting the whole system and reducing the urge to drink. The study was surprisingly successful. Compared to primates that received a placebo IV, those that received the growth factor gene decreased their drinking by about 90%. They basically quit drinking, while the primates that got the placebo resumed their habit. A similar procedure is already used in patients with Parkinson's disease. But more animal studies, and human clinical trials, would be needed before this therapy could be used in humans with alcohol use disorder. This invasive treatment involves brain surgery, which has risks, so it would likely be reserved for those with the most severe, dangerous drinking habits. "I think it'd be appropriate for individuals where other treatment modalities just weren't effective, and they're worried for their lives," Grant said. Alcohol Use Disorder Treatments Today, treatment for alcohol use disorder ranges from a brief conversation with a health care provider, in mild cases, to psychiatric treatment or medication in moderate or severe cases. FDA-Approved Medications for Alcohol Use Disorder There are four FDA-approved treatments for alcohol use disorder and a few more medications that health care providers can prescribe off-label. "They're not widely used," said Henry Kranzler, MD, a professor of psychiatry and director of the Center for Studies of Addiction at the University of Pennsylvania Perelman School of Medicine. "They're shockingly underutilized." One reason: Just 4.6% of people with alcohol use disorder seek treatment each year, according to NIH data. "Some of the issues include the ubiquity of alcohol, and its acceptance in American culture – and the fact that that makes it difficult for people to acknowledge that they have a problem with alcohol," said Kranzler. But another problem is that many health care professionals don't recognize and treat alcohol use disorder in patients who do seek care. Those seeking treatment for alcohol use disorder can find a qualified provider at the American Academy of Addiction Psychiatry or American Society of Addiction Medicine directories. The Future of Treatment Advances in the science and treatment of alcohol use disorder Ongoing research could lead to more treatments, and make them more available and more appealing. Unlike many other drugs that work on a single receptor in the body – like opioids that target opioid receptors, or nicotine, which targets choline receptors – alcohol affects many different receptors, said Robert Swift, MD, PhD, a professor of psychiatry and human behavior at Brown University Alpert Medical School. It also penetrates cells at high doses. "There are so many different effects of alcohol, which makes it very hard to treat," he said. "But on the other hand, it gives us an advantage, and there are probably different points that we can attack." Other exciting developments are underway, although more research, including clinical trials in humans, is needed before they arrive. Some of the most promising: Hallucinogens. In the 1950s, before they became illegal, these trippy drugs helped people drink less. Even Bill Wilson, co-founder of Alcoholics Anonymous, used hallucinogenic treatment in his recovery; it helped him envision overcoming a challenge. Today, there is renewed interest in hallucinogens for alcohol use disorder. In a study published in JAMA Psychiatry , people with alcohol use disorder who were given the hallucinogen psilocybin along with therapy spent fewer days drinking heavily over the following 32 weeks than people who received a different medication. Don't try to do this yourself, though. "It's not just taking a hallucinogen and having a trip," Swift said. "It's a therapy-guided session, so it's a combination of using the hallucinogenic substance with a skilled therapist, and sometimes two skilled therapists, helping to guide the experience." What Are Hallucinogens? Common Types of Hallucinogens CRISPR technologies for precise epigenome editing Epigenetic editing. Alcohol exposure can affect the activity of a gene in your amygdala, a brain region involved in emotional processing. Researchers at the University of Illinois at Chicago found that by editing that gene in rats through an IV of genetic material, they reduced the rodents' drinking and anxiety. Tell Me All I Need to Know About Oxytocin Oxytocin. The so-called love hormone, produced by your brain when you hug your partner, could help reset the dopamine system to make alcohol less appealing. "There are oxytocin receptors on dopamine neurons, and oxytocin makes your dopamine system more effective," Swift said. In a recent study from the Medical University of South Carolina, mice injected with oxytocin didn't drink during a stressful situation that could have otherwise led to relapse. Nutrients | Free Full - Text | Molecular Mechanisms and Health Benefits of Ghrelin: A Narrative Review Ghrelin. This stomach hormone that helps you stay full could help curb drinking. In a study published in Neuropharmacology , mice that received drugs that increased ghrelin reduced their alcohol intake.

Amy Palmer discusses the strength of fentanyl compared to other opiates during a naloxone training event on July 8 at The Dandy Lion Cafe in Ashland, Missouri. The next training event is scheduled for Sept. 12, but Palmer said the goal is to host events monthly fentanyl epidemic Fentanyl 101: What You Need to Know The fentanyl epidemic is getting worse in Missouri, with record numbers of overdoses in the last four years and 2023 on course to be another record year. Data points to a nearly 75% increase in overdoses in Missouri since 2019, and last year was the second consecutive year that fentanyl accounted for over two-thirds of overdoses in Missouri. Trends in Missouri match what the U.S. Drug Enforcement Administration describes as a “nationwide overdose epidemic” fueled by the spread of fentanyl. The drug has a place in reducing suffering when its use is deliberate and controlled. Diluted to thousandths of a milligram and administered by medical professionals, fentanyl can relieve pain in half the time it takes morphine and without its unpleasant side effects. However, it takes merely one grain of salt’s worth of fentanyl to cross into a fatal dose. The drug is up to 50 times more powerful than heroin and far cheaper to produce. It can also be spliced into various drugs to make counterfeit pills that can be fatal. Counterfeit pills are often disguised as legitimate prescription drugs such as Oxycontin, Xanax, Vicodin, Adderall and Percocet and are increasingly culprits in fentanyl overdoses. Overdoses can occur when victims believe they are using cocaine or pill-based drugs that don’t usually prove fatal, according to the DEA. For every 10 fentanyl-laced counterfeit pills created, six contain a dose that can kill, the agency said in a public notice. Earlier in June, nearly 1,000 counterfeit Percocet pills laced with fentanyl were recovered in one traffic stop in Miller County. Nationwide, DEA seizures of counterfeit pills containing fentanyl have risen by 430% since 2019. The DEA released a letter in 2021 warning federal, state and local law enforcement about so-called “mass-overdose” events — three or more overdoses at the same time and place. “Fentanyl is killing Americans at an unprecedented rate,” according to DEA Administrator Anne Milgram. “Drug traffickers are driving addiction, and increasing their profits, by mixing fentanyl with other illicit drugs. Tragically, many overdose victims have no idea they are ingesting deadly fentanyl until it’s too late.” Amy Palmer discusses the strength of fentanyl compared to other opiates during a naloxone training event on July 8 at The Dandy Lion Cafe in Ashland, Missouri. The next training event is scheduled for Sept. 12, but Palmer said the goal is to host events monthly. Citizens make a difference Amy Palmer, an emergency responder who works at Columbia/Boone County Public Health and Human Services, said she’s seen overdoses across all ages, races and socioeconomic classes. Emergency services will typically know a “bad batch” has hit town because of a sudden burst of overdose calls, she said. Palmer also works as an educator with the University of Missouri-St. Louis Addiction Science team and recently led a 45-minute class to teach participants how to administer naloxone, a synthetic drug that inhibits opiate receptors in the nervous system while reversing adverse effects. Throughout the course of this Save-a-Life class, attendees receive step-by-step instructions about naloxone to keep a person alive while waiting for first responders. Students are given 4mg doses, typically enough to save a life. If a first dose isn’t effective, emergency responders can administer additional doses until the patient is revived. Eighty-five percent of revivals recorded by UMSL are achieved within two doses. In the last two years, records from Palmer’s EMS station show that her team has administered naloxone 189 times. The procedure has reversed a number of potential deaths in Boone County. Missouri Institute of Mental Health data shows that no more than four people given naloxone in Columbia perished each year from 2018 to 2022. Save-a-Life training is often attended by people with no background in emergency medical aid, or “good Samaritans,” said Heather Harlan, who has also been an instructor. She said family members and friends of those with substance use disorder seek out the class. “We don’t ask questions — they get training and they get naloxone,” she said. Good Samaritans Brian Adermann, who works in grounds and maintenance at Rock Bridge Memorial State Park, attended a recent class. Three weeks before the training, Aldermann said he noticed a half-conscious stranger with a needle in their arm in a parked car. Adermann’s first thought was fentanyl overdose. He knocked on the window, and the stranger slowly sobered up and drove away. If it had been an overdose, Adermann said he wouldn’t have known what to do. So, he decided to attend the training. A recent UMSL report suggests that fire police, EMS and clinicians account for only slightly more naloxone administration than friends, significant others, parents and strangers like Aldermann. As of April 2023, citizens made up 47% of reported naloxone administrations, with emergency personnel taking responsibility for nearly 50%, approaching an even split, according to UMSL data. The UMSL Addiction Science Team responsible for the data set qualifies its findings, saying that results are “limited to those who (have) been trained and (feel) comfortable completing it,” and that its figures are likely a “large underestimate” of non-fatal overdoses in Missouri. Harlan said residents can no longer expect to avoid witnessing an overdose event — a person slumped in a public space and unresponsive — and as the first person on scene they’re best equipped to give the victim the best shot of survival. Camaron Nielsen, a volunteer for Heart of Missouri CASA, court-appointed special advocates for children in foster care, came to the training as part of her continuing education. As an advocate for children in foster care, Nielsen said she knows fentanyl might reach those communities too, so she wants to be prepared. “It (drug use) is something that is an unfortunate reality so we try to be knowledgeable about it,” she said. Since October 2021, Boone County has received 908 boxes of naloxone, and nearly all have been distributed. For those who haven’t seen an overdose in their circle of friends or acquaintances, it’s difficult to understand fentanyl overdoses, Harlan said. But stories she’s heard make the impact on the community clear. “We too casually say that ‘this is a choice,’” and dismiss the problem as a moral failing, Harlan said. “When people ask me, ‘well why do people use drugs?’ Pain is why.”

Tobacco dependence was significantly lower among polyusers of cigarettes, e-cigarettes, cigars, as well as dominant smokeless product users. HealthDay News — Cigarette-dominant tobacco users have a higher level of tobacco dependence (TD), according to a study published online July 26 in Nicotine and Tobacco Research. Lihua Li, Ph.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues examined tobacco use (TU) profiles and their associations with TD over time among 3,463 adult recent tobacco users. TU profiles were identified by applying a latent class analysis based on participants’ usage of 8 common tobacco product groups at each of waves 1 to 4 of the Population Assessment of Tobacco and Health study. Researchers identified 3 distinct TU profiles that remained consistent across the 4 survey waves: dominant cigarette users; polyusers with a high propensity of using traditional cigarettes, electronic cigarettes, and cigars; and dominant smokeless product users (62 to 68%; 24 to 31%; and 7 to 9%, respectively). Compared with dominant cigarette users, TD was significantly lower among polyusers and dominant smokeless users. “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,” Li said in a statement. Full Article

How many children in your community are on ADHD medications? Do you know how important it is to find out? It may be time for a new nightly public service announcement. Throughout the 1970s, American TVs warned “It’s 10 o’clock. Do you know where your children are?” Today a more fitting message might be, “Young kids abuse mental health meds. Do you know how many of your child’s schoolmates have an ADHD prescription?” A national study published earlier this year showed that ADHD drug abuse among U.S. high and middle school students has been rising for the past 20 years. The problem is more than 30 times greater in some schools than others. The main factor affecting the magnitude of the problem is the percent of ADHD-diagnosed students in a school. More children diagnosed equates to more drug abuse. While ADHD drug abuse may be a problem in school communities around the country, significant risk factors for abuse were schools located in suburban neighborhoods and schools with highly educated and primarily white populations. Like the opioid epidemic, ADHD drug abuse may be most evident outside inner cities but that doesn’t mean it’s not a problem in urban communities too. ADHD prescribing rates are important because ADHD often represents a gateway diagnosis not only into the mental health system but also into the world of youthful drug experimentation. Once diagnosed, many children experience a cascade of psychotropic prescriptions—drugs used to treat mental health problems. Stimulants like Adderall and Vyvanse are often prescribed first, but tolerance to the drug effects can develop quickly or induce adverse effects. This often leads doctors to switch up and add on various drugs. In the U.S., 40% of ADHD-diagnosed 2- to 24-year-olds are on multiple types of psychotropics concurrently. Even the use of powerful antipsychotics—the drugs once reserved for treating adults with schizophrenia—has become a common part of ADHD treatment. A diagnosis of ADHD has been implicated in 25 percent of antipsychotic adverse drug reactions. In the past, access to local ADHD prescribing rates would have required academic professionals to secure grant money to support labor-intensive research. That’s no longer the case. Thanks to the proliferation of electronic health record systems (EHRs), information about a community’s rate of prescribing ADHD drugs and other mental health meds is sitting in databases begging for air. Without violating patient privacy or confidentiality, it would be relatively easy for a hospital or health system to generate “de-identified” rates of drugs prescribed to children for ADHD or any other mental health conditions. De-identified information does not include names or other personally identifying information. It is limited to 3-level zip codes (except when fewer than 20,000 individuals reside in the specified geographic region). It includes only aggregate information such as the percent of individuals under 18 who have been diagnosed with ADHD. As individuals who spent much of our careers conducting scientific investigations on the prevalence and impact of mental health diagnoses and drug treatment trends, we value the ease with which communities could now learn about their mental health trends. In the early to mid-2000s, our research documented that ADHD treatment rates were many times higher than nationally recognized ADHD experts insisted were possible. One of the most prominent ADHD authority figures of the time came to southeastern Virginia (SEVA), which includes Virginia Beach, Norfolk, Portsmouth, and several surrounding cities. He told community members to ignore reports of ADHD overdiagnosis. But when SEVA citizens saw how high its rate of ADHD prescribing was, they took decisive action. Through the help of a community coalition of key stakeholders and community movers and shakers, SEVA systematically decreased ADHD treatment by 32 percent while also developing non-drug interventions that improved educational outcomes. Unfortunately, individuals with financial ties to the pharmaceutical industry attacked and derailed the community-based work beyond repair, as first mentioned in Anatomy of an Epidemic by Robert Whitaker and more recently in Deconstructing ADHD, a volume edited by Eric Maisel. As detailed in Shooting the Messenger: The Case of ADHD, effort was taken to convey to the medical community and the public that the SEVA epidemiologic and intervention research was based on fabricated data to suit an anti-medication agenda and that the research was being conducted without proper informed consent. One of us (Gretchen LeFever Watson) was the lead researcher at the time. Here’s what happened: The attacks on my credibility culminated in an anonymous false allegation of scientific misconduct. The allegation was leaked to the press and Eastern Virginia Medical School (EVMS) confirmed that one of its faculty members was under investigation for scientific misconduct. A local newspaper reporter began pestering the researcher’s staff and community collaborators and local K-12 school officials about the research and their role in it. Local pediatricians affiliated with the medical school became increasingly hostile toward me. Pediatric neurologist Dr. Donald Lewis repeatedly threatened me and rebuked me in an email: “repeated news media reports, fueled by your reports, which depict our clinicians as quick-triggered, pill-pushers undermines the credibility of the Children’s Hospital [Children’s Hospital of The King’s Daughters, CHKD, in SEVA] as well as our community partners.” Lewis was one of the principal investigators for an EVMS-affiliated clinical research organization that had contracts with over 40 pharmaceutical companies, including numerous ADHD clinical drug trials. At some point during the investigation, a K-12 school administrator reportedly marched into the medical school dean’s office complaining that they had been misled about consent procedures. This allegation was false, and wholly unsupported by the record. Fear on the part of medical and school officials of legal action and press scrutiny apparently created an atmosphere in which the self-preservation instinct overcame solid factual analysis. The looming threat of a scandalous newspaper expose about local ADHD research had the potential to become a public relations nightmare. The unsubstantiated claim by a local school administrator was the straw that broke the camel’s back. The medical school placed me on leave without pay, permanently terminated my federally funded research, and promised school officials that my data—which were collected at taxpayer expense and with the expectation of full public dissemination—would never be used for any reason. Contact with my staff was severed and I was forced to communicate with the medical school through an attorney, which racked up expenses while on leave without pay. Because EVMS terminated my research, the U.S. Centers for Disease Control and Prevention (CDC) asserted that it was forced to severe their cooperative agreement and withdraw grant funding for my portion of a multisite investigation of the prevalence and impact of ADHD—the portion of the study that was also investigating the prevalence and impact of depression, bipolar disorder, obesity, parenting strategies, sleep hygiene, and related health issues. EVMS eventually cleared me of all wrongdoing. However, as an institution that does not offer tenure, it simply failed to renew my contract the following year. Despite having a copy of official documentation clearing me of scientific misconduct, a local newspaper story was published which implied my ADHD research may have misled the public and “missed the mark.” The ordeal led to the total dismantling of a public health approach to improve ADHD care which had the potential to serve as a national model for reducing overuse of psychotropic drugs while also improving educational and behavioral outcomes among school-aged children. This included cancellation of programs designed to systematically manage behaviorally challenging children, improve school-provider communication, teacher training and education, and parent education and support. It also led to the termination of the nation’s first public health psychology internship—a clinical psychology internship program approved by the American Psychological Association. That, in a nutshell, is how an originally anonymous, unsubstantiated complaint led to the termination of a very promising line of research. Imagine if instead of relying on a single faculty member writing and securing grant funding to collect information from research subjects, the work had been overseen by a community task force that monitored data trends captured by EHRs. It would have been much more difficult for people to cancel the work because it conflicted with their financial interests. Today, the latter approach is possible, but first people must be alerted to the fact that there is reason to be concerned about psychotropic overprescription and that EHR data can help to clarify the extent of the problem. This is especially true in places like SEVA, where the healthcare is dominated by one large, integrated healthcare system and a single pediatric hospital and its affiliated practices. The benefit of hindsight indicates that SEVA was an epicenter, if not the epicenter, for psychotropic overprescription in children. By 2000, data demonstrated that about 19 percent of the region’s elementary school students were medicated for ADHD, with 28 percent of those students on two or more types of psychotropics concurrently. Early on, this unprecedented level of psychotropic prescribing was associated with surprisingly poor educational outcomes. Since then, the most definitive national study of ADHD treatment modalities documented that ADHD drug treatment led to worse outcomes than other options. In that federally-funded longitudinal study, known as the MTA study, researchers monitored ADHD treatment outcomes among children who were randomly assigned to various treatment modalities. During the initial assessment, stimulant drugs appeared to reduce ADHD symptoms. However, by the 3-year follow-up, children who were taking stimulants had worse outcomes than those who were not. Stimulants use “was a significant marker […] not of beneficial outcome, but of deterioration. That is, participants using medication in the 24- to 36-month period actually showed increased symptomatology during that interval relative to those not taking medication,” the researchers wrote. One of the MTA researchers, Dr. William Pelham, has repeatedly sought to convey to the public that, over the long haul, stimulant drugs are not as effective as commonly believed. “We had thought that children medicated longer would have better outcomes. That didn’t happen to be the case. The children had a substantial decrease in their rate of growth, so they weren’t growing as much as other kids in terms of both their height and their weight. And the second was that there were no beneficial effects—none,” he said in a 2007 Daily Telegraph interview. These results were reinforced by a 2022 study conducted by Pelham and others showing that, while ADHD children taking stimulant medication sat in their seats longer and got more work done in the short run, they did not learn any more academic material than when they were not taking stimulants. Other research has confirmed the association between stimulant drugs and a deterioration in functioning on both educational and social-emotional measures. Analyzing a massive and longitudinal set of data from children across Canada, a Princeton University professor documented the downside of long-term use of stimulant drugs. Expanding the use of ADHD drug treatment “had little positive benefit and may have had harmful effects given the average way these drugs are used.” Though not precisely understood, the “mechanism of action of prescription stimulants is not drastically different from that of cocaine and MA [methamphetamine, known also as meth].” Moreover, 70 to 80 percent of all individuals (whether or not they are diagnosed with ADHD) experience an initially favorable response to stimulant medication, according to Dr. Larry Diller, pediatrician, and author of Running on Ritalin. In a PBS interview, Diller explained that people can get a dopamine “rush” from taking a prescription stimulant, cocaine, or methamphetamine. He also noted that few people realized that methamphetamine, which is generally considered dangerously addictive, is listed in Physician’s Desk Reference as a treatment for ADHD, much like stimulants more commonly prescribed (Ritalin, Adderall, Vyvanse, etc.). “Rates of overdose deaths from psychostimulants [ADHD pills] have been increasing since 2010,” according to the CDC. The U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA) is now warning of a new wave of addiction stemming from stimulants like Ritalin and Adderall, as well as cocaine and methamphetamine. It is increasingly common for people in drug rehabilitation programs to report that their drug experimentation began with ADHD pills. In 2018, John Eadie, a project coordinator for the National High Intensity Drug Trafficking Areas, told WebMD, “No one is paying attention to this. Everyone, correctly, is focused on opioids and should be because of the known problem there. But this other problem is catching up with us very rapidly.” According to Eadie, law enforcement agents are seizing fifteen times more kilograms of stimulants than opioids. ADHD prescriptions surged during the COVID-19 pandemic, again raising questions about the appropriateness of ADHD care. Is it possible that things would have turned out differently for millions of people suffering with substance abuse problems if efforts to publicly report on trends first observed in SEVA had not been quashed by pharmaceutical industry interests? We’ll never know, but the data sitting in EHRs in every U.S. community might offer insights that could make a difference in the future of countless children, families, schools, and communities. Several organizations have sponsored a petition to raise awareness about the problem of psychotropic overprescription among U.S. children and calls for the potential to use de-identified EHR information to monitor and publicly report psychotropic prescribing rates at the community level. The authors and sponsors of the petition believe community-level reporting could help reverse our society’s tendency to “medicate normal.” An award-winning documentary film with the same title exposes the underappreciated problem of widespread use of psychotropics, especially when used long-term. How many children in your community are on ADHD drugs or other psychotropics? For those who might be interested, the petition can be found here. *** Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own. *** Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site. Gretchen LeFever Watson Dr. Watson is a clinical psychologist, academic affiliate of the University of South Carolina College of Pharmacology, and Vice President of the Institute for the Study of Integrated Healthcare Advisory Council at Utica University. She is the author of Your Patient Safety Survival Guide: How to Protect Yourself and Others From Medical Errors. Contact her at gwatsonphd@gmail.com. David O. Antonuccio is a Professor Emeritus in the Dept. of Psychiatry and Behavioral Sciences at the University of Nevada School of Medicine, where he taught for 32 years. Concurrently, he worked for 24 years at the V.A. Medical Center in Reno. He has also had a private practice for more than 35 years. He served on the Nevada State Board of Psychological Examiners from 1990 to 1998. His clinical and research interests include the behavioral treatment of depression, anxiety, and smoking.

The prevalence of mental disorders among children was higher in those with families that had lower annual incomes and high BMI. Risk for any child mental disorder was elevated among boys and children from homes with lower annual incomes and high BMI, according to results of a study published in the Journal of the American Academy of Child & Adolescent Psychiatry. There have been few robust and recent studies about trends in mental disorders among children in the United States. As such, this study was designed to be a current snapshot of the prevalence of and trends in mental disorders among children aged 9 to 10 years in the US. Investigators at Columbia University, New York, New York, sourced data from the Adolescent Brain Cognitive Development (ABCD) study which recruited 11,874 children from 21 sites in the US between 2016 and 2018. The overall prevalence of mental disorders and associations with sociodemographic and physical characteristics were evaluated. The children comprised 52.15% boys, 55.79% were White, 24.18% were Hispanic, 13.78% were Black, 62.51% had a healthy weight, 73.60% were born to a mother that was aged 20 to 34 years, 67.18% of parents were married or living with a partner, and 43.43% lived in a home with an annual income of $75,000 or higher. "[T]he findings highlight the threat posed by poverty to the mental health of children, especially to their liability to develop disruptive behavior disorders." Any mental disorder was observed among 10.11% of children. The most prevalent conditions were mood disorders (3.11%), anxiety disorders (2.90%), attention-deficit/hyperactivity disorder (ADHD; 2.73%), and disruptive behavior disorders (2.52%). The average number of disorders per child was 0.15%

Long-term methylphenidate treatment is not likely to be associated with growth impairments. Two years of treatment with methylphenidate for attention-deficit/hyperactivity disorder (ADHD) did not affect growth outcomes among children. These results from a study were published in The Lancet Psychiatry. The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) study was a prospective, pharmacovigilance, multicenter study conducted between 2012 and 2016 at 27 mental health centers in the United Kingdom and in other countries in Europe. Children and adolescents with ADHD who were treatment-naïve and about to start methylphenidate (n=756) or had no intention to start methylphenidate (n=391) and a group of healthy controls (n=263) were followed for 2 years. The outcomes of interest in this study were height, weight, cardiovascular health, and psychiatric outcomes. The methylphenidate, no treatment, and control groups comprised children with mean ages 9.22, 8.74, and 10.25 years (P <.0001); 82.2%, 84.1%, and 45.2% were boys (P <.0001); 92.1%, 95.4%, and 92.4% were White; and they had BMIs of 18.4, 17.9, and 18.4 kg/m2, respectively. Methylphenidate appeared to slow weight velocity at 6 months compared with ADHD nonusers (P <.0001), however, no differences in weight were observed thereafter, nor were there any significant group differences in height or BMI throughout the study. "[T]he results of this study suggest that the safety profile of long-term treatment with methylphenidate for 2 years is acceptable." At 12 months, methylphenidate use associated with significantly elevated pulse rate, systolic blood pressure, and diastolic blood pressure (all P <.0001) compared with nonusers with ADHD. Between baseline at 24 months systolic blood pressure increased from 108 to 113 mmHg (P <.0001) among methylphenidate users and from 104 to 108 mmHg (P <.0001) among nonusers with ADHD while remaining unchanged among controls (mean, 109 vs 111 mmHg; P =.08), respectively. In addition, significant increases in diastolic blood pressure (mean, 65 vs 67 mmHg; P =.02) and pulse (mean, 80 vs 83 bpm) were observed among methylphenidate users between baseline and 24 months, respectively.

Profiles of sleep problems were related with behavioral and emotional during the transition from childhood to adolescence. During the transition from childhood to adolescence, a study published in JAMA Psychiatry identified profiles of sleep problems which were related with behavioral and emotional problems. Investigators from the University of Melbourne in Australia sourced data for this study from the Adolescent Brain Cognitive Development (ABCD) study which was an observational cohort study conducted in a community setting in the United States. Caregivers of children (N=10,313) completed the Sleep Disturbance Scale for Children (SDSC) and the 113-item Child Behavior Checklist (CBCL) instruments at baseline and at a 2-year follow-up between 2016 and 2020. The change in sleep problems and their relationship with psychopathology symptoms during the transition from childhood and adolescence were evaluated. Sleep pathology was defined as a SDSC t score of 70 or greater and internalizing, externalizing, and total problems were defined as SDSC t scores of 65 or greater. At baseline, the children were mean age 119 (SD, 7.51) months, 52.4% were boys, 54.0% were White, they had a BMI of 18.7 (SD, 3.72) kg/m2, and 42.7% had a parent with psychopathology. "The identification of discrete sleep profiles suggests that interventions should target specific patterns of sleep problems as an alternative to nonspecific targeting of sleep difficulties." At baseline, 7.9% met the criteria for sleep problems, 8.9% for internalizing problems, and 8.8% for externalizing problems. At follow-up, the proportion who met the criteria for sleep (7.8%) and internalizing (8.8%) problems were similar but the proportion who met the criteria for externalizing symptoms had decreased from baseline (7.3%).

The likelihood of developing cognitive impairment or Parkinson disease in adulthood may be tied to experiencing frequent nightmares in childhood. Experiencing distressing dreams in childhood may be associated with an increased risk for cognitive impairment and Parkinson disease (PD) during adulthood, according to study findings published in the journal eClinicalMedicine. Several recent studies have shown that the occurrence of frequent bad dreams and nightmares among adults may be an early sign or a potentially modifiable risk factor for the development of both PD and dementia — with the latter known as a type of cognitive impairment. Evidence also suggests that experiencing regular distressing dreams in the middle adult years may be linked to an elevated risk for PD or cognitive impairment a few decades later. In the current analysis, researchers sought to explore whether having distressing dreams during childhood can be linked to the risk for PD or cognitive impairment by age 50. For the longitudinal analysis, researchers utilized 50 years of prospectively obtained data from the 1958 British Birth Cohort Study to investigate the possible link. The British Birth Cohort Study is a prospective birth cohort that comprised all individuals who had been born in Great Britain during a single week in 1958. The base study population comprised 11,721 individuals who were enrolled at birth in 1958, and had information available on distressing dreams in 1965 (at age 7) and in 1969 (at age 11). Following numerous study exclusions, the final analytical sample included a total of 6991 children with follow-up available at age 50. "[I]t is possible that early treatment of distressing dreams could become a primary prevention strategy for dementia and PD." All of the data gathered on the children’s distressing dreams were collected prospectively from their mothers in 1965, then again in 1969. The mothers were requested to report whether their child had experienced “bad dreams or night terrors” in the prior 3 months by providing a “yes” or a “no” response. The participants were divided into 3 groups, according to the presence or lack thereof of distressing dreams at ages 7 and 11:

The new generation of safe and effective weight loss drugs seems to have helped boost the US profile of such medications and has fueled interest in nearly half the US adult population. A recent survey of more than 1000 US adults showed that 18% were "somewhat interested" in taking a "safe, effective" weight loss drug, 27% were "very interested," and 4% said they were already using such an agent, together constituting 49% of the surveyed adults. The newer, more potent and generally safe agents that work by stimulating receptors to nutrient-stimulated hormones, such as incretins like glucagon-like peptide-1 (GLP-1), seem to drive this interest. When asked, "How much have you heard, if anything, about a new class of drugs being used for weight loss, such as Ozempic, [semaglutide formulated and approved for people with type 2 diabetes], Wegovy, [semaglutide for weight loss], and Mounjaro, [tirzepatide, currently only approved for treating people with type 2 diabetes]?" 43% said they had heard some, or a lot, about these agents. This was particularly true among people at least 65 years old, who had a 55% prevalence of knowing some, or a lot, about these new weight-loss agents, while an additional 26% had heard at least "a little" about them, reported staff members of KFF (formerly the Kaiser Family Foundation) in a report posted online in early August. Weight-Loss Drugs Garner 'Increasing' Attention "A new class of prescription drugs, initially developed to treat type 2 diabetes, have been garnering an increasing amount of attention due to their ability to act as highly effective weight-loss drugs for overweight or obese adults," write the report’s authors. However, surveyed interest fell markedly when respondents answered further questions that hinged on certain limitations of the newer weight-loss formulations.

High frequency of discrimination and microaggressions in health care settings were reported by Black patients with serious illness. HealthDay News — Epistemic injustice is the most common manifestation of racism experienced by Black patients with serious illness and is associated with worsened mistrust and negative patient-clinician communication outcomes, according to a study published online July 5 in JAMA Network Open. Crystal E. Brown, M.D., from the Cambia Palliative Care Center of Excellence at the University of Washington in Seattle, and colleagues examined whether experiences with racism are associated with patient-clinician communication and decision-making among Black patients with serious illness. The analysis included data from semistructured interviews conducted with 25 Black patients with serious illness hospitalized at an urban academic medical center between January 2021 and February 2023. Researchers found that the participants had substantial socioeconomic disadvantage and reported high levels of medical mistrust and high frequency of discrimination and microaggressions experienced in health care settings. The most common manifestation of racism participants reported was epistemic injustice, including silencing of their own knowledge and lived experiences about their bodies and illness by health care workers. These experiences made participants feel isolated and devalued, especially if they had intersecting, marginalized identities, such as being underinsured or unhoused. These experiences exacerbated existing medical mistrust and poor patient-clinician communication. “These findings suggest that race-conscious, intersectional approaches may be needed to improve patient-clinician communication and support Black patients with serious illness to alleviate the distress and trauma of racism as these patients near the end of life,” the authors write. Full Article