November 5, 2021

Good morning, MindSite Newsletter readers. In today’s newsletter, we’ll share a disturbing new study that links cannabis use in nearly 250,000 pregnant women with elevated levels of depression and anxiety. You’ll also read about a new approach to harm reduction taking shape in San Francisco that attempts to get at the root of fentanyl overdoses, an enormous problem across the country. And we’ll tell you about a commentary detailing how the American workplace is ill-prepared to handle the grief of employees affected by loss from COVID-19.   

“The American workplace isn’t prepared for this much grief”

The numbers say it all: 740,000 Americans have been killed by the COVID-19 virus, more than in any other country. Nearly three-quarters of Americans (72%)  know someone who has died or been hospitalized because of the virus, resulting in an outward rippling of grief to more than 6.6 million people, according to one study. All of these numbers portend a groundswell of grief for which employers are woefully ill-prepared, according to an article in The Atlantic.  

Many employees suffering from complicated grief need time off to mourn, for example, but paid leave for bereavement is scarce. Low-wage workers are the least likely to be given time off – paid or otherwise. Some states, like New Jersey and New York, are considering proposals that require such leave. Without such support, author Chad Broughton concludes, “American workers, at least for now, will have to shoulder those burdens with no guarantee of relief.”

San Francisco’s Street Overdose Response Team Brings Help Where it’s Needed

In San Francisco and other cities grappling with the explosive increase in opioid overdose deaths, public health officials are reinventing how they respond to the crisis, with fentanyl, a powerful synthetic opioid,  being the main target, according to an article from KQED radio. “Fentanyl is a game changer,” Dr. Hillary Kunins, the city’s director of behavioral and mental health services, says of the synthetic opioid that’s up to 100 times stronger than morphine. “It requires a new way of thinking and resourcing.” What it comes down to, Kumins told KQED, is entirely rethinking what it takes to prevent people from overdosing. That means working across agencies and recognizing that people overdose not simply because of substance issues, but because of their mental health and lack of housing, food and other necessities. A pilot program known as the Street Overdose Response Team, which brings together firefighters and registered nurses, is attempting to make inroads. 

Marlins baseball team works with Miami students to shore up their mental health 

Winning may seem to be the end goal in competitive sports, but the Miami Marlins have partnered with  a nonprofit called the Positive Coaching Alliance to teach students how to embrace losing – and use it to move ahead without falling apart, according to a story in the Miami Herald. They are working together with students in the Miami-Dade Public Schools to teach sports in a way that puts students’ mental health front and center. “Everything we do is based around social-emotional learning,” said Molly Whittaker, a program director for the Positive Coaching Alliance, which serves as a catalyst for a positive youth sports culture and provides evidence-based training and resources for coaches, parents, and athletes across the country. “If athletes are comfortable with making mistakes and learning from them, they will be much more successful in the long run,” she told the Herald. 

The program is part of a mental health and safety initiative by the Florida Department of Education following the 2018 shooting at a high school in Parkland, which killed 17 faculty members and students. The Miami-Dade district used its funds to create a department for mental safety and worked with the Marlins last year to set up 125 workshops at 18 schools — a number that will increase to 27 schools this year. Daniel Luque, a soccer player at Hialeah Gardens High, said the program improved his resilience. “With COVID, I was affected a bit,” he said. “It put me on the right track…it definitely gave me a mental edge.” The Marlins have also recently joined the coaching alliance in a new Sports Can Battle Racism curriculum for student athletes.  

Cannabis use disorder among pregnant women is on the rise 

Photo: Shutterstock

In a review of more than 20 million hospital discharges published in JAMA Psychiatry, Columbia and Weill Cornell researchers found cannabis use disorders increased 150 percent in pregnant women hospitalized from 2010 to 2018, according to a release from Columbia University. “This is the largest study to document the scale of cannabis use disorder in prenatal hospitalizations,” said study co-author Claudia Lugo-Candelas, PhD, assistant professor of clinical medical psychology at Columbia’s Department of Psychiatry. Researchers identified nearly 250,000  pregnant patients who were hospitalized for cannabis use disorder and found that they had elevated levels of depression, anxiety and nausea, suggesting they’re not getting the care they need, according to the researchers. Some 58% of the women were identified as having mood disorders. 

Marijuana legalization and decriminalization may contribute to a more relaxed attitude about its use during pregnancy, the researchers suggested. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have recommended against its use because of known effects on the fetus, including low birth weight. But neither group has yet warned against using cannabis during pregnancy on the grounds of mental health.

Ketamine is gaining traction as a depression treatment, but some experts say not so fast 

It used to be a club drug during the counterculture 1970s known as “Special K.” But in recent years, ketamine, an anesthetic, is being widely used in clinics to treat depression in people who’ve gotten little benefit from traditional treatments, according to an article in the New York Times. Since early studies began showing that ketamine offers relief – sometimes immediate – for drug-resistant depression and other mood disorders, hundreds of ketamine providers have opened up shop around the country, offering ketamine intravenously or in a nasal spray. While relief might be immediate, evolving research suggests that weekly or biweekly sessions over the course of six to eight weeks are needed for prolonged relief. But not everyone is a convert. “I understand the rush for ketamine, in both private and public clinics,” said Dr. Carolyn Rodriguez, director of the Translational Therapeutics Lab at Stanford University. She led a small, early trial of ketamine to treat obsessive compulsive disorder and saw an impressive and immediate decrease in symptoms. But given the lack of long-term data, the potential for troubling side effects and the possibility for abuse, she says “ketamine is not yet ready for safe general use.”

In the US, if you or anyone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255.

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Laurie Udesky reports on mental health, social welfare, health equity and public policy issues from her home in the San Francisco Bay Area.