A radical response to a historic crisis

Monday February 27, 2023

By Don Sapatkin

Today’s Daily offers some equally intriguing and well-reported stories: What really happened during the country’s first officially sanctioned supervised injection site’s first year? A comprehensive study that analyzed a vast array of data finds that physical activity doesn’t just improve depression and anxiety ─ it works far better than psychotherapy and antidepressants. And a look at how a new federal policy allowing Medicaid behind bars could be a game changer.

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“One year inside a radical new approach to America’s overdose crisis”

Early last year, George Cosme came to a building on East 126th Street in East Harlem to inject heroin. It usually takes several minutes for an excess of opioids to trigger the kind of respiratory crisis that can kill a person, but Cosme’s overdose was almost instantaneous. His face turned bright purple just moments after the drug entered his bloodstream. His body went almost rigid with clenching. He lost consciousness and then, in a matter of seconds, stopped breathing.

But Cosme had come to the nation’s first publicly sanctioned supervised consumption room, then a couple months old. The overdose prevention specialist sprang into action, injecting 0.4 milligram of naloxone into his thigh muscle, then tilted his chair back onto the floor in the brightly lit room, laid him flat and inserted a thin tube connected to an oxygen tank and an artificial breathing unit. The rest of the room descended into an anxious silence as the staffer used the Ambu bag to breathe for Cosme, slow and steady, in and out. The woman who had come with him to inject heroin was crying in the corner.

A staffer prayed softly. Several others were on deck, standard policy in cases like these in case the overdose was the result of a bad batch that multiple people were using. (It wasn’t.) With no response after 20 minutes, the room broke out in a chorus: “George! Come back to us, George!” Eventually, Cosme’s eyes blinked open. “Look at all you beautiful people,” he said. The room went rowdy with applause.

Scientist-turned-journalist Jeneen Interlandi takes us through several scenes at OnPoint, the New York City nonprofit that operates the consumption site (and showers, laundry, and a massage center), for an opinion piece in the New York Times. She follows OnPoint’s three mobile vans as they stop at certain intersections and homeless camps where staffers exchange dirty needles for clean ones, and offer toothbrushes, tampons, Pop-Tarts, wound care kits and warm socks, often to people they’ve known for months if not years. It’s all part of the harm reduction approach that builds the necessary trust over time to urge users into treatment.

An accompanying New York Times editorial reviews how America’s battle with drug addiction, while improved, is still failing. The last time the federal government spent more on public health than on law enforcement was during the Nixon administration (which later reversed course). The Times also recommends policy solutions. One is to amend state and federal laws that so far have allowed only New York City to open safe consumption sites. (Rhode Island passed a law allowing them.) Another: Build an actual system for the treatment of addiction.

Huge study of studies finds exercise more effective than meds or therapy for depression and anxiety

Study after study has shown that exercise can improve mental health. Not that anyone listens. But you might want to pay attention to this one, which the authors say is “the most comprehensive synthesis to date of evidence regarding the effects of all modes of [physical activity] on symptoms of depression, anxiety and psychological distress in adult populations.”

The key finding: Exercise of various sorts and durations was 53% more effective, on average, than both medication and psychotherapy. Its conclusion and recommendation were unusually direct: “Physical activity should be a mainstay approach in the management of depression, anxiety and psychological distress.”

The research article, published in BMJ’s British Journal of Sports Medicine, hasn’t gotten much attention beyond medical news sites and a piece in the New York Post, which noted that the Centers for Disease Control and Prevention doesn’t even mention exercise as a form of treatment. The authors downplayed the striking result in their paper – a University of South Australia press release did not – and the exercise-vs.-pharmacology-and-psychotherapy comparison was stated in statistical terms that would be unfamiliar to laypeople. It undoubtedly will be tested by other researchers.

Read the full MindSite News story here.

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Why Medicaid behind bars promises big change on the outside

Lee Reed spent his first night after getting out of prison sleeping in the stairwell of a San Francisco parking garage. He’d been imprisoned for two decades, and his agonizing back pain inside had followed him out. “Imagine somebody standing on your foot, and you can’t stop that pain,” said Reed, days shy of his 62nd birthday. “It’s going to be there when you wake up. It’s going to be there when you go to sleep. Half the time I never even got out of bed while I was in prison because I couldn’t stand up, it was so painful.”

His doctors in prison told him he needed back surgery, but because he was so close to his release date, he’d have to get it outside. He saw an operation as his ticket to being able to get a job and reenter society. But without health insurance or a support network, being able to do any kind of work seemed impossible as he laid down in the concrete stairwell, his prison-issued walker his only blanket. “I was tired, and I was literally ready to give up,” Reed said.

In a story, podcast and transcript, the health policy site Tradeoffs explores the implications of highly anticipated changes in federal law that for the first time allow Medicaid to be offered in jails and prisons. Fifteen states from across the political spectrum have applied, and their plans vary widely. California was the first to be approved, last month, and expects to begin coverage in April 2024. Although it was too late for Reed, he did eventually get his back surgery, about six painful months after he was released from prison.

Tradeoffs host Dan Gorenstein interviewed him by phone for the podcast, letting Reed’s experience show the complex interplay of issues that face inmates upon release: no housing, no job, no friends, and a world that moved forward in countless ways while they were behind bars. For many, getting health care and substance abuse treatment competes for attention with all of them.

Yet incarcerated people have higher rates of chronic medical conditions and much higher rates of serious mental illness and addiction, making their release, and easier opportunity to do drugs, a dangerous time: One study found that during the first two weeks following release from prison, people were 12 times more likely to die than the general population. Another found that they were 40 times more likely to die of a drug overdose. Federal guidance on how states could use Medicaid to provide substance use treatment before release is expected this spring.

Getting enrolled in Medicaid before release and continuing seamlessly afterward is a game-changer. Interviews with experts looked at the ways that states are thinking about the transition from prison – and the potential for unintended consequences. Astonishingly, current and former senior officials in three states’ Medicaid programs told Tradeoffs they could think of only a couple of potential downsides: Judges might sentence people to prison to enable them to receive services. Prisoners might hesitate to enroll because they might view Medicaid as part of a criminal justice system they don’t trust. Finally, CMS officials have some concerns that jails and prisons might offload their health care costs onto Washington, so they included some protections in the California approval.

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In other news…

Christopher W.T. Miller, a psychiatrist, psychoanalyst and supporter of talk therapy explains in easy-to-understand language how psychotherapy works in the brain. Miller, who practices at the University of Maryland Medical Center, offers three tips for bringing the lessons of psychotherapy into everyday life. “In many ways, it comes down to how we treat our own thinking,” he wrote in the Washington Post: Choose reflection over reflex. Bring softness, not hostility. And be curious, not judgmental.

The exploding popularity of canned and bottled alcoholic drinks ─ hard seltzers, wine coolers and cocktails packaged for casual consumption ─ is concerning regulators and public health experts, the New York Times reported.

With alcohol-related deaths up by one-third between 2019 and 2021, they worry that the convenience and ubiquity of the new products could alter how Americans drink alcohol and reverse the long-term decline in consumption by young people. PepsiCo and Coca-Cola have debuted alcoholic products in the U.S. market for the first time, and energy drink-maker Monster Beverage this month rolled out its first line of alcoholic drinks, The Beast Unleashed, with a high-profile NASCAR tie-in. Sales of hard seltzers and ready-to-drink canned cocktails were valued at nearly $10 billion in 2021 by Grand View Research, which projected double-digit growth in the coming years.

Data brokers are selling information about Americans’ mental health on the open market with minimal vetting of purchasers or controls on how it is used, JD Supra reported. The consultancy cited a study from Duke University’s Sanford School of Health Policy that found 11 of the 37 data brokerage firms contacted by a potential “purchaser” were willing to sell the requested data with little to no knowledge of how it might be used. Ten brokers advertised data for sale on consumers specifically with depression, insomnia, anxiety, and bipolar and attention deficit-hyperactivity disorders. They also sold data targeted by ethnicity, birth date, zip code, single-parent status and other factors that companies can cross-reference to create profiles used to target advertising or secretly assess individuals’ health care costs or for other, unknown purposes. An especially concerning finding: many brokers implied that that they could provide not just aggregated information, but also identifiable data related to individuals’ mental health conditions.

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.