July 19, 2022

By Don Sapatkin

Good Monday morning! Today’s MindSite News Daily reports on two studies, one important and the other fascinating: The first showed that long-criticized restrictions on methadone treatment for opioid addiction could be safely lifted, opening access to far more people. The other, a first of its kind, found that an AI-derived algorithm was shockingly accurate at predicting which handgun buyers would soon die by suicide. We also introduce you to Mckenzie, a young homeless woman in Hollywood who takes the Los Angeles Times on a harrowing journey. And, in case you haven’t heard: 988 is live!

Meet Mckenzie, young and pregnant and just evicted from her tent

LA Times via Twitter

Mckenzie Trahan, 22 years old and 6-1/2 months pregnant, sobbed into her phone outside a Denny’s restaurant in Hollywood, Calif. as she scanned an embankment above the 101 Freeway looking for a group of tents. While she’d been in court, a state transportation crew had demolished the site and now her tent with built-in lights and a blow-up mattress were gone, along with her new laptop, birth certificate, housing papers and prenatal vitamins.

“I was like, ‘No, no, no, hell no,’” Mckenzie told the Los Angeles Times, recalling that evening in August 2018. A team of reporters set out that year to bring the rest of us into the heartrending world of traumatized young adults and produced a riveting, 8,000-word narrative story (and coming video documentary) that follows several years of McKenzie’s life.

It’s hard not to like Mckenzie, a bright young woman with rainbow-colored hair, sparkle and wit and too many horrible experiences to count. Some of them came with the troubled family she was born into, others due to her own bad choices – all compounded by a mind-bogglingly dysfunctional child welfare and social services system. Mckenzie’s baby, Ann, was born healthy and HIV-free, met all developmental milestones and seemed happy and thriving in her mother’s care. The reporters follow McKenzie as she bathes Ann and hauls her in a stroller from one appointment to another in an attempt to keep her. It doesn’t work: On her first birthday, Ann us removed and placed in foster care (as were Mckenzie’s two older boys) following allegations of neglect.

Rarely is a cynical old journalist so touched by a story that he tries to squeeze so much into a newsletter item. This piece, along with striking photos and video clips of Mckenzie in her ever-changing environment, is worth your time.

Analysis of overdose deaths supports lifting restrictions on methadone

Image: Shutterstock

Methadone is a highly effective but vastly underused treatment – an addictive opioid that substitutes for more problematic opioids, allowing users to lead relatively normal lives. Federal restrictions on access to the treatment have limited its use for decades – but now a new study covered by the Associated Press suggests those limits can be safely eased.

Methadone treatment expanded dramatically under President Richard M. Nixon who feared heroin addiction among returning Vietnam veterans would doom his efforts to cut violent crime and his reelection. But concerns about patient safety and diversion for resale led to the requirement that most patients travel to clinics to swallow their daily doses in front of a staff member.

Then came Covid-19. Overdose fatalities involving all drugs skyrocketed and the federal government amended the rules to allow providers to dispense 14 or 28 days  of take-home methadone. The new study, released last week, found that fatal overdoses involving methadone held steady over the next 17 months studied while deaths related to all other drugs continued their inexorable rise.

The research letter and accompanying graphics, published in JAMA Psychiatry, support a federal decision four months ago to temporarily extend the at-home rule and consider making it permanent. “This evidence adds significant weight to the argument that effective treatment for substance use disorders should be offered in an accessible and practical way that works for people who need it,” Nora Volkow, a coauthor and director of the National Institute on Drug Abuse, said in an agency press release.

Long-awaited 988 mental health crisis line goes live

988, the three-digit  mental health crisis line went live nationwide over the weekend, allowing people experiencing a mental health crisis to more easily call or text the National Suicide Prevention Lifeline for help 24/7.

Through the service, trained counselors will help people in suicidal crisis and other kinds of mental health and emotional distress and, as needed, help them access an mental health professionals, the New York Times explained in a what-you-need-to-know article. The hotline will be able to connect callers with local crisis teams in some states. Advocates have warned that the service, which depends largely on local centers and state funding, is under-resourced and would not be ready on time. States have dealt with the challenges in very different ways, as Cal Matters reported in a story about California’s plans posted on MindSite News last week.  

Machine learning’s promise for suicide prevention, and its limits

A proof-of-concept study that relied on a form of artificial intelligence to identify handgun buyers at high risk of suicide offers tantalizing evidence for next-generation prevention programs, The Hill reported. Firearms are used in more than half of suicides in the United States.

The researchers, assisted by machine learning, generated 41 “predictor variables” based on an analysis of handgun-purchase transactions by two million individuals from 1996 to 2015 in a comprehensive California database that contains information on virtually every firearm purchase or transfer as required by state law. They then cross-referenced the data against state death records from 1996 to 2016 to test the algorithm’s ability to predict who was likely to die by suicide. The findings, published in JAMA Network Open, found that individuals placed among the 5% at highest risk made up nearly 40% of gun-suicide deaths over the next year; the highest 10% accounted for half the deaths.

Using machine learning to develop a predictive algorithm has lots of theoretical applications for suicide prevention — but won’t work in most states. “Only 11 states currently require licensed dealers to report identified firearm sales information to law enforcement,” wrote the University of California, Davis researchers. “Risk prediction such as we have demonstrated here is not possible in other states.”

In other news…

Gabby Giffords Won’t Back Down, a new documentary about the former Arizona congresswoman’s near-assassination, difficult recovery and journey to activism gets an overall mixed review but watching it “feels almost necessary” in an age of mass shootings, Michael O’Sullivan writes in the Washington Post. You can watch a trailer and find local showtimes here.

Starbucks said it would shutter 16 locations in five major cities, citing threats to worker safety stemming from a growing mental health crisis, homelessness, substance abuse and general “social and economic upheaval” since the start of the pandemic. The company has declined to discuss what specific incidents and how many of them led to the closures, ABC News reported.

YouTube has agreed to pay $4.3 million to settle a class action lawsuit alleging the company failed to protect content moderators who regularly view violent and disturbing videos from psychological harm, Reuters reported. The agreement must be approved by a federal judge.

An annual report on the linked epidemics of drug, alcohol and suicide deaths looks back more than two decades and finds three distinct waves that were dominated by different combinations of drugs and devastated different demographic populations. The report, jointly produced by Trust for America’s Health and Well Being Trust, includes some nifty graphics. 

If you or someone you know is in crisis or experiencing suicidal thoughts, call the National Suicide Prevention Lifeline at 988. Or contact the Crisis Text Line by texting HOME to 741741. En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889. Services are free and available 24/7.

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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...