Monday, January 9, 2023

By Don Sapatkin

Good Monday morning! Gender identity and mental health in public schools continue to be the focus of state legislation and culture wars. The Food and Drug Administration has approved a new Alzheimer’s drug that few people will be able to afford.

An innovative recovery center is helping stressed-out Ukrainian soldiers. An investigative story looks at the the questionable practices of sober living homes. Another examines how insurers with Medicare Advantage contracts erect barriers to opioid treatment. And finally: I broke down the Top Ten Mental Health stories of 2022 in a story published last week.

Top Mental Health Stories of 2022

2022 was the year mental health was fully embraced as a national issue. It was a year of unprecedented attention and funding. For many, it was a year of fear and anxiety.

Insurance companies with Medicare plans impeding access to substance use treatment

Two years after Medicare began paying for opioid treatment programs for the first time, providers say their efforts are being hindered by the private insurance companies that block or delay access to the programs, which use methadone and other medications to help reduce opioid use and overdoses. The insurers administer benefits to about half the Medicare population through Medicare Advantage (aka Part C) plans that entice subscribers with low or no premiums and may include extras like dental coverage and  gym memberships.

The insurers keep costs down by limiting provider networks and requiring prior authorization. But these tactics impede access to patient care, treatment providers told Roll Call, a news outlet that covers Congress. This creates a potentially deadly risk to people grappling with addiction who might return to illicit drugs to avoid withdrawal if they don’t get prompt assistance.

Treatment programs must generally get prior approval from insurers in order to be reimbursed for their services, a process that can take days or weeks. A Kaiser Family Foundation analysis last year found that 85 percent of people enrolled in Medicare Advantage are subject to prior authorization requirements for opioid treatment coverage. The plans also are slow to issue payments and make it difficult for providers to join their networks, Roll Call reported.

In December, the Biden administration proposed new rules that would impose limits on how Medicare Advantage plans use prior authorization and require them to state clearly when advance approval is needed. The rules also mandate that the plans follow Medicare coverage rules when determining whether treatment is “medically necessary” rather than creating their own guidelines.

FDA approves new Alzheimer’s drug, but effectiveness and cost are question marks

The FDA approved a new drug, lecanemab, for people with early Alzheimer’s disease that that may modestly slow cognitive decline but carries a hefty price tag – and safety risks such as swelling and bleeding in the brain, the New York Times reported. Drug companies have been trying and failing for decades to develop truly effective treatments for Alzheimer’s and existing drugs have limited benefits.

Findings from a large clinical trial showed that patients taking the new drug, which will be marketed as Leqembi, declined 27% more slowly over 18 months than those given a placebo. But two researchers wrote in a review article that it was unclear whether the slower decline would be enough for patients to notice. Stories about the approval noted the deaths of three patients who experienced brain swelling and bleeding – events that have not been conclusively linked to the drug.

Eisai, the pharmaceutical company that led the drug’s development, set a price of $26,500 a year and it is unclear whether Medicare will cover the costs. Without coverage, few people could afford it. The approval came through the FDA’s accelerated approval program, which clears drugs of uncertain benefit if they are for serious diseases that have few available treatments. The approval follows the FDA’s controversial decision in 2021 to clear another Alzheimer’s drug, Adulhelm, even though senior agency officials and an independent advisory committee had recommended denial. Medicare declined to cover it for most patients and set rules that would also apply to Leqembi.

Lack of regulation allows ‘sober living homes’ to operate with few checks

When a 32-year-old woman named Kaitlyn applied for a spot at a sober living home run by Hope Center Ministries in Clancy, Montana, in late 2021, it seemed like her best option. She’d been found to have violated her probation and told her probation officer she’d been using methamphetamine. Her public defender advised her that entering the 34-bed women’s sober home would allow her to get out of jail, provide some recovery support in a structured environment and help her comply with probation requirements.

But the program had no doctors on staff and she never worked with a licensed addiction recovery specialist, according to a Montana Free Press investigation. For much of her stay, she worked 40 hours a week without pay at a burrito restaurant owned by Sodexo, a national food services company that held a vocational training contract with Hope Ministries. She was asked to apply for SNAP food benefits, and to turn them over to staff to buy groceries (the fridge and cupboards were locked outside designated mealtimes). Neither Hope Ministries nor Sodexo responded to the paper’s questions.

Hope Ministries describes itself as a “drug addiction treatment center” on its Facebook page and on its website says its purpose is to “lead addicts and their families to become fully devoted followers of Christ.” The drug and alcohol recovery industry generally is poorly regulated, and regulation of sober homes is so light that even the number of homes nationwide is unknown.

Over the years, multiple news organizations have reported similar findings. The Department of Justice created a “Sober Homes Initiative” in 2020 that has resulted in fraud charges against 13 people charged with defrauding health care programs of more than $934 million, according to a DOJ report.

For Ukrainian soldiers, a place to de-stress and recover from combat

A local commander in the Ukrainian military transformed a Soviet-era sanatorium into a recovery center for service members stressed and exhausted after 10 months of relentless war. Uniformed soldiers take short breaks to restore their bodies and minds before going back to the front line. Sitting in comfy armchairs in a dimly lit room smelling of lavender and pine trees, the men draw deep breaths as they close their eyes and listen to meditative music, the Associated Press reported.

More than 2,000 soldiers have been treated at the rehabilitation center since it opened in the Kharkiv region in June with funding from partners in the U.S. and Europe. Treatments include aquatic therapy in a hot pool to heal muscle aches; red light therapy to improve heart and blood circulation; a salt room for better breathing; and for those having nightmares, a type of electrotherapy said to relax the nervous system and induce sleep. Psychologists are also available.

“This rehabilitation is helping soldiers, at least for a week, to put themselves together,” Oleksander Vasylkovskyi, a lieutenant colonel in the Ukrainian Armed Forces who spearheaded the center’s creation, says in a video as men exercise on mats and in the pool. A soldier named Maksym hadn’t seen his wife and son in five months. One of the hardest parts of this war, he said, is when “you can’t connect and speak to your loved ones.” He was relieved they could join him for a few days at the rehabilitation center and relax together.

Gender and mental health wars continue

A Texas lawmaker introduced a “don’t say gay” bill that bars classroom discussion of sexual orientation all the way through 8th grade and also requires schools to disclose to parents all information learned about a student’s mental health. If passed, the policy could lead to gay children being forced out of the closet by school officials, the Advocate reported. A very different approach is underway in Massachusetts, where outgoing Attorney General Maura Healey announced the release of a comprehensive Mental Health and Gender-Affirming Care Resource Guide for LGBTQ2IA+ Young People ─ and was sworn in the next day as the state’s first lesbian governor. 

In other news…

A distressing 94% of people 12 and older with a substance use disorder didn’t receive treatment in 2021, Behavioral Health Business reported, one of many disheartening statistics in the latest National Survey on Drug Use and Health. And a new report from the Centers for Disease Control and Prevention found that overdose deaths among teens 14 to 18 increased 94% from 2019 to 2020 and 20% from 2020 to 2021, far greater that among adults.

Psychedelics roundup: For a how-to story on using psychedelics in psychotherapy, check out this piece from Katie Couric Media…Race and ethnicity seem to have an important role in how psychedelic use impacts mental health outcomes, according to PsyPost‘s coverage of a study in the Journal of Psychopharmacology…A single dose of psilocybin plus therapy significantly decreased depressive symptoms in an industry-backed clinical trial that followed 52 participants for 14 days…And NBC News reports that ketamine clinics for mental health are springing up around the U.S. ahead of evidence of broad benefits.

Providing media literacy education to students in New Jersey public schools, as required by recently enacted legislation, will help children’s developing brains defend against a firehose of content that boosts their jealousy, insecurity, outrage and fear, wrote Julie Scelfo, a longtime journalist who now directs a nonprofit initiative called Get Media Savvy.

Use of P2P meth, a more potent and highly addictive type of methamphetamine, is surging around the country, NBC News affiliates in Portland reported. Although dangerous on its own ─ “it very quickly scrambles your brain permanently,” said Mayor Ted Wheeler ─ P2P often is mixed or taken with fentanyl, an overdose-multiplying combination whose rise was chronicled by journalist Sam Quinones in The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth.

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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Type of work:

Don SapatkinReporter

Don Sapatkin is an independent journalist who reports on science and health care. His primary focus for nearly two decades has been public health, especially policy, access to care, health disparities...