Can a Psychedelic Clinical Trial Really Be Blinded?

Monday, May 15, 2023

By Don Sapatkin

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Psychologists offer tips for parents on social media practices. Critics ask: What about the tech co’s?

Staggering numbers of young people are experiencing loneliness, anxiety and depression − and social media is part of the problem. So the American Psychological Association has stepped in with 5 top recommendations aimed at helping parents teach adolescents how to safely use social media and limit their screen time. Tips include ways to discuss the recommendations with kids, along with suggestions for training kids in in social media literacy before they start consuming it and for monitoring their feeds once they do, NPR reported.

Also important: modeling health social media practices yourselves. (To wit: Put your own phone away during family meals!) Another 5 suggestions – and the science behind them – are detailed in a separate Health Advisory on Social Media Use in Adolescence.

APA chief Arthur C. Evans says adolescents should be routinely screened for signs of “problematic” social media use: “Is it getting in the way of your child’s sleep and physical activity? Is it getting in the way of their school, or other activities that are important in their development? Or is it hard for them to detach from social media?” Parents should also be on the lookout when they’re monitoring their child’s social media use, Evans says.

But some therapists told NPR the recommendations place too much burden on parents – and too little on tech companies. Even implementing this guidance will require action from tech companies and perhaps regulators.

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A new approach to managing fentanyl withdrawal? And can a psychedelic clinical trial really be blinded?

Buprenorphine is one of the most effective medications for treating opioid addiction. It binds to receptors in the brain to prevent other opioids from attaching – and doesn’t normally cause withdrawal symptoms. But fentanyl, now found in a huge portion of street drugs in the U.S., is so powerful that patients trying to kick it by transitioning to buprenorphine – brand name suboxone – may experience withdrawal sickness so bad that they stop treatment.

A trio of West Coast physicians say they’ve found a novel solution, Stat reports. Providing tiny doses of ketamine – a legal anesthetic, mind-bending at higher doses – as patients start buprenorphine treatment eliminates withdrawal symptoms. “Think of it like a buprenorphine amplifying agent,” Thomas Hutch, a Seattle addiction doctor, told Stat. Hutch and his colleagues presented their approach, based on experience with about 20 patients to doctors at the American Society of Addiction Medicine’s annual conference in April. While promising, the number of patients treated with the combo is small and no randomized trial has been conducted or peer-reviewed research published.

There are none so blind… The best clinical trials are “blinded” so participants and researchers don’t know which subjects received an intervention and which got a placebo. This avoids bias that could occur when someone thinks they got a real pill – and as a result thinks they feel better. But some trials are especially hard to blind. Really, who couldn’t tell the difference between fake, inactive pills and psylocibin (even when they look identical)?

In a recent review of 86 psychedelics studies, nearly all of them – 94% – attempted blinding, but only 17% assessed whether the blinding worked. And guess what: Most of those found it didn’t. In one study, 94% of participants correctly guessed whether they’d received psilocybin or a placebo. The systematic review was described in The Microdose, a newsletter from the UC Berkeley Center for the Science of Psychedelics.

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Possible explanations for the ‘gender well-being gap’

Women worldwide are more likely than men to say they are depressed, lonely, anxious, frustrated, sad and having trouble sleeping. Yet when women are asked on more general surveys about happiness and overall satisfaction with life, they are often at least as positive as men. New York Times economics columnist Peter Coy explored the potential reasons for this paradox with experts including David Blanchflower, a British-born economist at Dartmouth College who co-authored a working paper on the issue.

Perhaps it’s due to the burdens – and rewards – of motherhood. Or perhaps women have lower expectations and also find it easier to acknowledge their depression.

Perhaps living in a world that, even today, “is patriarchal − structured by men, for men,” makes women more likely to suffer from depression and anxiety.

Women’s relatively high sense of life satisfaction may also stem from having a backup way to derive satisfaction that many men don’t allow themselves – being a great parent. Or maybe women say they’re happy because doing so seems appropriate – or they simply have lower expectations and aspirations than men.

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The mental health system keeps failing New Yorkers

“Revolving door mental health − that is, forcibly institutionalize, forcibly medicate, stabilize, discharge back into the same environment, and then repeat the cycle.” That’s how a judge described New York City’s approach to mental health care in the late 1980s. Thirty-five years later, little has changed – as was all too evident from the killing of Jordan Neely in an F-line subway car on May 1. Writer Adam Iscoe took a comprehensive look at an incomprehensible system in a piece for The New Yorker.

Well over 200,000 New Yorkers live with a severe mental illness. Only about 5% are homeless – but that still adds up to 13,000 people with schizophrenia, bipolar and major depression living at overcrowded shelters, in subways or on the street. And not surprisingly, some act out in hostile or even violent ways.

If they appear to be a danger to themselves or others, police or emergency medical services workers will take them to the nearest hospital emergency department for evaluation – and that happens 70,000 times a year. About half go to a psychiatric unit, where the average stay − if they are admitted − is just 13 days.

Quick discharges are partly the result of a shortage of inpatient beds, which is partly because good-quality psychiatric care is less profitable than specialized spinal surgeries and hernia repairs, according to The New Yorker. Publicly funding enough beds would cost a fortune; building them would take many years. If patients refuse treatment or ask to be released, only a court order can keep them there. “The NYPD,” the story notes, “is, in effect, the largest psychiatric-outreach team in America.”

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In other news…

Lots of honors in the 2023 Pulitzer Prizes for coverage of mental health and addiction:
• Eli Saslow of The Washington Post won for his feature stories about people struggling with addiction and homelessness – like one that followed the route of the Number 15 bus-line in Denver.
• Christina House of the Los Angeles Times won in feature photography for her intimate look at the life of a mentally ill 22-year-old woman living on the street.
• The Washington Post‘s coverage of the fentanyl crisis earned it a finalist.
• So did Joaquin Palomino and Trisha Thadani’s look at the city’s failure to provide safe housing for homeless people in the San Francisco Chronicle.

See the full list of winners here, including the Pulitzer Prize for fiction: “Demon Copperhead,” by Barbara Kingsolver, described as “a masterful recasting of ‘David Copperfield,’ narrated by an Appalachian boy whose wise, unwavering voice relates his encounters with poverty, addiction, institutional failures and moral collapse − and his efforts to conquer them.”

Blacks and Hispanics are less likely to receive opioid treatment medications than whites after comparable events, according to research findings in the New England Journal of Medicine. The study of nearly 26,000 Medicare claims involving non-fatal overdoses, hospitalizations and rehab/detox treatment involving opioids found that the treatment medication buprenorphine was given within 180 days to Black patients 13% of the time compared with 19% for Hispanics and 23% for whites. The numbers were similar with naloxone, an overdose reversal medication.

The National Maternal Health Hotline received over 12.000 calls and texts in its first year, NBC News reported. The hotline, launched last Mother’s Day, provides free and confidential emotional support, resources and referrals 24/7 to pregnant and postpartum individuals who struggle with mental health concerns, and their loved ones. It also has a new number: 1-833-TLC-MAMA (1-833-852-6262).

“The Mother Who Changed: A Story of Dementia” is a fascinating, nuanced New York Times magazine article about the complex relations among parents with dementia, their adult children and personal autonomy….In other dementia news: The FDA approved Rexulti (brexpiprazole) oral tablets as the first drug to treat agitation associated with Alzheimer’s dementia. And a study in JAMA Internal Medicine estimated it would cost $2 billion to $5 billion to extend Medicare coverage to Leqembi (lecanemab), a drug the FDA described as providing “modest clinical benefit” to patients with early-stage Alzheimer’s dementia.

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.

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