Talk: Can we predict and #prevent #suicide?

Students are rolling back into town, and many of them will already be stressed out. Some will try suicide; some will succeed.

As the CDC reported this summer, suicide rates are rising.

Can suicide be prevented?

A top researcher asking that question will be in town Thursday. It’s a bit of a hoof and in the middle of the day, but Maria Oquendo. of UPenn will be at McLean Hospital for a talk on on “Suicidal Subtypes: Delineating Phenotypes to Identify Underlying Biosignatures.”  Noon, Service Building, Pierce Hall.   Details.

Find some of her work here.

Her effort dovetails with that of Matthew Nook of Harvard, who was described in an NYTimes article as “the suicide detective.” 

From the CDC

Suicide is a leading cause of death in the US. Suicide rates increased in nearly every state from 1999 through 2016. Mental health conditions are often seen as the cause of suicide, but suicide is rarely caused by any single factor. In fact, many people who die by suicide are not known to have a diagnosed mental health condition at the time of death. Other problems often contribute to suicide, such as those related to relationships, substance use, physical health, and job, money, legal, or housing stress. Making sure government, public health, healthcare, employers, education, the media and community organizations are working together is important for preventing suicide. Public health departments can bring together these partners to focus on comprehensive state and community efforts with the greatest likelihood of preventing suicide.

States and communities can:

  • Identify and support people at risk of suicide.
  • Teach coping and problem-solving skills to help people manage challenges with their relationships, jobs, health, or other concerns.
  • Promote safe and supportive environments. This includes safely storing medications and firearms to reduce access among people at risk.
  • Offer activities that bring people together so they feel connected and not alone.
  • Connect people at risk to effective and coordinated mental and physical healthcare.
  • Expand options for temporary help for those struggling to make ends meet.
  • Prevent future risk of suicide among those who have lost a loved one to suicide.

 

 

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In Spanish and English: Staying safe in super hot weather

Probably won’t wear long sleeves but…

Capture

 

Public health advocates at Harvard have some video recipes to help cooks stay on the healthy side.

Muffins,  farrow and more.

A variety of diced vegetables are slow-roasted and mixed with whole-grain farro in this hearty, satisfying dish. You can easily change the recipe depending on the season, to include summer or winter produce and herbs. View the full recipe

From Harvard Chan Cooks:

 

 

 

 

 

 

Can comics help us heal? Graphic medicine exhibit comes to UMass Med in the fall.

A few recommendations from Noes

Also note: Noes’  The Graphic Medicine Book Discussion Kit.

 

UMass doc comments on pediatricians statement re: plastic food containers

Umass doc weights in on this. Also see research from Silent Spring Institute.

AAP release here.

nci-vol-1926-150
NIH photo

 

From Times: “Because hormones act at low concentrations in our blood, it is not surprising that even low-level exposures to endocrine disrupters can contribute to disease,” said Laura N. Vandenberg, an assistant professor in the department of environmental health sciences at the University of Massachusetts-Amherst’s School of Public Health, who spoke on behalf of the Endocrine Society.

 

After Opioid Overdose, Only 30 Percent Get Medicine To Treat Addiction via KHN and WBUR, in Spanish and English

Study by BMC docs.

Story by Martha Bebinger at WBUR

See English version below or listen here.capture

Luego de una sobredosis de opioides, solo el 30% recibe tratamiento contra la adicción


Más de 115 estadounidenses mueren al día por sobredosis de opioides. Muchos otros sobreviven gracias al antídoto naloxone. Pero un nuevo estudio halló que solo 3 de cada 10 pacientes revividos por un paramédico o en una sala de emergencias reciben el tratamiento de seguimiento que puede evitar una futura tragedia.

El estudio, publicado en Annals of Internal Medicine, hizo el seguimiento de 17,568 pacientes de 2012 a 2014 en Massachusetts. Observó las tasas de supervivencia a lo largo de ese tiempo y si los pacientes habían recibido medicamentos para tratar la adicción.

De los pacientes que sí recibieron medicación, 3,022 adultos tomaron buprenorfina, conocida con el nombre comercial de Suboxone, y 2,040 pacientes recibieron metadona. Al año, el grupo que utilizó Suboxone tuvo una tasa de mortalidad 40% más baja, comparado con aquellos que no recibieron ningún medicamento. Los resultados de la metadona fueron aún más potentes: una tasa de mortalidad 60% más baja.

Alrededor del 6% de los pacientes estaban consumiendo el bloqueador de opioides naltrexona (su nombre comercial es Vivitrol), pero en general solo por un mes. No tenían más probabilidades de estar vivos después de un año que aquellos a quienes no se les ofreció terapia o no tomaron un medicamento.

Phill y Deana están en tratamiento por su adicción a la heroína. Phill dijo que encontró una luz de esperanza con el tratamiento con Suboxone que recibe en el programa para personas sin techo del Boston Health Care. (Jesee Costa/WBUR)

“El hallazgo sorprendente es que tenemos tratamientos efectivos para las personas que sobreviven a una sobredosis, pero solo 3 de cada 10 reciben esos medicamentos”, dijo el doctor Marc LaRochelle, autor principal del estudio.

LaRochelle dijo que aconsejar el tratamiento debería ser tan común como la recomendación de rutina de tomar aspirina a los pacientes que han tenido un ataque al corazón.

“La reducción de la mortalidad que vemos con estos medicamentos es similar a la de una persona que sufre un ataque cardíaco y que luego consume aspirina. Es uno de los tratamientos más efectivos que tenemos en medicina”, dijo LaRochelle, médico de atención primaria e investigador del Centro de Adicción de Grayken en el Boston Medical Center.

Pero señala una gran diferencia: el 98% de las personas en este país reciben aspirina para prevenir un ataque cardíaco.

La brecha en la atención es similar a los hallazgos de un estudio en el Reino Unido, pero la investigación de Boston es la primera en seguir a pacientes estadounidenses atendidos en un hospital o por técnicos médicos, dijo la doctora Nora Volkow, directora del Instituto Nacional sobre el Abuso de Drogas (INAD).

“A diferencia de otras crisis que hemos vivido en el país, ahora contamos con estrategias efectivas de tratamiento que podrían abordarse y salvar vidas”, escribió Volkow en un editorial que se publicó junto con el estudio. “Sin embargo, decenas de miles de personas mueren cada año porque no han recibido estos tratamientos”.

Para entender por qué tan pocos pacientes reciben metadona o buprenorfina, solo se necesita cruzar la calle del Boston Medical Center, donde trabaja LaRochelle. Hay clínicas que ofrecen ambas drogas, y hay un intercambio de agujas, enfocado en la reducción de daños para usuarios de drogas que todavía están en adicción activa. En las primeras horas de la mañana, algunos hombres y mujeres hacen fila para recibir su dosis diaria de metadona, otros comienzan el día con una inyección de heroína o fentanilo, y dos hombres intercambian billetes arrugados por dos tabletas azules.

Scott, un hombre de 38 años de Lowell, se apoyó contra la pared de un edificio. Dijo que tuvo varias sobredosis, pero que no le ofrecieron Suboxone hasta después de la tercera.

“El problema es que muchos de estos médicos no quieren recetar algo así después que la persona tiene una sobredosis porque sienten que abusarán del medicamento”, dijo Scott. (solo se mencionan los nombres de pila en la historia porque todavía pueden estar comprando drogas ilegales).

Scott admitió que ha abusado de Suboxone. Tanto Suboxone como la metadona son medicamentos que contienen opioides. Si se toman tal cual se recetan, bloquean la adicción.

Pero con Suboxone, “mucha gente toma dosis más altas, lo que provoca una reacción más fuerte, o lo venden para tener dinero”, dijo Scott.

Otros lo mezclan con alcohol u otros medicamentos, lo que causa efectos distintos. Pocos médicos están capacitados o tienen experiencia para tratar adicciones tan complejas. Scott dijo que “entiende por qué son reacios a recetar cosas” como Suboxone.

Algunas veces es el paciente quien es reacio a comenzar un tratamiento asistido por medicamentos.

“Existe la percepción que las personas no están ‘limpias’, entre comillas, si no dejan de consumir todas las sustancias, y eso impide que sigan el tratamiento con medicamentos, que es lo más efectivo”, dijo Aubri, quien está tomando metadona y dice que funciona.

Pero Aubri dijo que la forma en que se entrega la metadona es degradante. A diferencia de Suboxone, que los pacientes pueden obtener de un médico de atención primaria durante una cita de rutina, la metadona está estrictamente controlada, por lo general solo disponible en clínicas designadas.

“Se siente como una cárcel”, dijo Aubri. “Hay rejas. Hay guardias de seguridad. Nadie quiere estar allí. La única razón por la que las personas van es porque lo necesitan”.

Muchas comunidades continúan rechazando solicitudes para abrir clínicas de metadona. Los pacientes en áreas rurales a menudo conducen más de una hora de ida y vuelta para tener su dosis diaria. Los obstáculos para la atención contribuyen a un sentimiento entre muchos pacientes adictos a opioides: que los médicos y hospitales simplemente no quieren ayudar.

“Nos tratan como basura”, dijo Deana, mientras abrazaba a su esposo Phill. “No somos así porque somos malas personas”. Ambos tienen historias de maltrato para compartir. Pero Phill está viviendo la experiencia opuesta tomando Suboxone, through a clinic at the Boston Health Care for the Homeless Program.

“Te dan asesoramiento, terapia. Es como una familia “, dijo Phill, haciendo una pausa se escucha la sirena de una ambulancia. “Te hacen sentir bienvenido y amado y te dan la sensación de esperanza que puedo tener una vida libre de drogas”.

Muchas cosas han cambiado desde el período 2012-2014 de este estudio. Cada vez más médicos pueden recetar buprenorfina y la cantidad de pacientes que pueden controlar ha aumentado de 100 a 275. Los hospitales están comenzando a prescribir buprenorfina en la sala de emergencias y a abrir clínicas sin cita previa para recibir atención de seguimiento. En Boston, hay una camioneta móvil que lleva la prescripción de buprenorfina a las calles.

A LaRochelle le preocupa que los pacientes, como se ha visto en este estudio, todavía no permanezcan en tratamiento por más de unos pocos meses y estén perdiendo los mejores años de sus vidas. Alrededor del 66% de las personas en el estudio tenían menos de 45.

“Necesitamos reevaluar cómo estamos brindando la atención y asegurarnos de que podamos mantener a la gente bajo tratamiento”, dijo LaRochelle.

Incluso con la tasa de solo 3 en 10 pacientes que reveló el estudio, Massachusetts todavía estaba ofreciendo un mejor tratamiento con medicamentos opioides que muchos estados hacia 2014. Esto se debe a que el 97% de los residentes del estado tienen seguro médico, la tasa más alta en el país. En muchas otras partes, es difícil encontrar a alguien que prescriba metadona o buprenorfina.

“Todavía tenemos un estigma abrumador para los pacientes con la enfermedad de la adicción”, dijo Sarah Melton, profesora de práctica farmacéutica en la Universidad Estatal del Este de Tennessee.

Volkow, de INAD, está alarmado por otro hallazgo. El 34% de los pacientes recibe al menos una receta para un opioide, y el 26% recibió una benzodiazepina durante los 12 meses posteriores a la sobredosis.

“Esto indica que las directrices que advierten contra la prescripción de opiáceos y su uso conjunto con las benzodiacepinas no se están siguiendo”, escribió Volkow.

After Opioid Overdose, Only 30 Percent Get Medicine To Treat Addiction via KHN and WBUR, in English

More than 115 Americans die every day of opioid overdose. Many more who overdose survive due to the antidote medication naloxone. But a study out Monday finds that just 3 in 10 patients revived by an EMT or in an emergency room received the follow-up medication known to avoid another life-threatening event.

The study, published in the Annals of Internal Medicine, followed 17,568 patients who overdosed on opioids from 2012 to 2014 in Massachusetts. It looked at survival rates over time and whether patients received medicines that treat addiction.

Of the patients who did receive medication, 3,022 adults were on buprenorphine, known by the brand name Suboxone, and 2,040 patients were on methadone. The Suboxone group had a 40 percent lower death rate after one year, compared with those who did not receive any medication. The results for methadone were even stronger: a 60 percent lower death rate.

About 6 percent of patients were on the opioid blocker naltrexone (brand name Vivitrol), but often for just one month. They were no more likely to be alive after a year than those who were not offered or did not take a medication.

“The stunning finding here is that we have effective treatments for people who survive an overdose but only 3 in 10 are getting those medications,” said Dr. Marc LaRochelle, lead author on the study.

Phill and Deana are in treatment for heroin addiction. Phill says he found a sense of hope with the Suboxone treatment he gets at the Boston Health Care for the Homeless Program.

For some perspective, LaRochelle mentions the routine recommendation that patients who’ve had another life-threatening event, a heart attack, take aspirin.

“The mortality reduction we see with these drugs is similar to giving someone who suffers a heart attack aspirin. It’s one of the most effective treatments we have in medicine,” said LaRochelle, a primary care physician and researcher at the Grayken Center for Addiction at Boston Medical Center.

But he points to a big difference — 98 percent of people in this country get aspirin for a heart attack.

The gap in care is similar to findings from a U.K. study, but this Boston-based research is the first to follow U.S. patients seen in a hospital or by EMTs, said Dr. Nora Volkow, who directs the National Institute on Drug Abuse.

“A great part of the tragedy of this opioid crisis is that, unlike in previous such crises America has seen, we now possess effective treatment strategies that could address it and save lives,” Volkow wrote in an accompanying editorial. “Yet tens of thousands of people die each year because they have not received these treatments.”

To understand why so few patients get methadone or buprenorphine, one need only cross the street from Boston Medical Center, where LaRochelle works. There are clinics that offer both drugs, and there’s a needle exchange, focused on harm reduction for drug users who are still in active addiction. In the early morning hours, some men and women were lining up for their daily dose of methadone, others were starting their day with a shot of heroin or fentanyl, and two men were trading crumpled bills for two blue tablets.

Scott, a 38-year-old from Lowell, Mass., leaned against a building. He said he has overdosed three or four times, but wasn’t offered Suboxone until after his third overdose.

“The problem is, a lot of these doctors don’t want to prescribe anything like that after the person has an overdose because they feel like they’ll abuse the medicine,” Scott said. We’re using only first names for people who may still be buying illegal drugs.

Scott admitted he has abused Suboxone. It and methadone are both opioid-based medications. Taken as directed, they block cravings for something stronger without making the patient high.

But with Suboxone, “a lot of people that get prescribed it, take a lot more than they’re supposed to and that gives you a high or they sell them to get money,” Scott said.

Others layer alcohol or other medications for a different kind of high. Few doctors are trained to or have experience managing such complex addictions. Scott said he “understands why they’re reluctant to prescribe stuff” like Suboxone.

Sometimes it’s the patient who is reluctant to start medication-assisted treatment.

“There’s a perception that people aren’t quote-unquote ‘clean’ unless they’re abstinent from all substances and that plays into keeping people away from medication treatment, which is the most effective treatment,” said Aubri, who is on methadone and says it works.

But Aubri said the way methadone is delivered is demeaning. Unlike Suboxone, which patients can get from a primary care doctor, during routine medical care, methadone is tightly controlled, typically only available at designated clinics.

“It feels like a jail,” Aubri said. “There’s literal bars across the gates that don’t open til a certain time. There’s security guards. No one wants to be there. The only reason people go is because they need it.”

Many communities continue to reject applications to open methadone clinics. Patients in rural areas often drive more than an hour each way to get their daily dose. The obstacles to care contribute to a feeling among many opioid addiction patients that doctors and hospitals just don’t want to help.

“They treat us like crap,” said Deana, as she hugs her husband Phill. “We’re not like this because we’re bad people, you know.”

Deana and Phill have an endless stream of stories about feeling mistreated in hospitals. But Phill is having the opposite experience now, taking Suboxone, through a clinic at the Boston Health Care for the Homeless Program.

“They give you the counseling, the therapy. It’s like a family,” said Phill, pausing as a ambulance wails by. “They make you feel welcomed and loved and give you that sense of hope that I can have a drug-free life. I don’t have to use.”

Many things have changed since the 2012-2014 period of this study. A growing number of physicians are allowed to prescribe buprenorphine and the number of patients they can manage has increased from 100 to 275. Hospitals are starting to prescribe buprenorphine within the emergency room and opening walk-in clinics for follow-up care. In Boston, there’s a mobile van that takes buprenorphine prescribing to the streets.

LaRochelle worries that patients, as seen in this study, are still not staying on treatment for more than a few months and are losing prime years of their lives. Some 66 percent of people in the study were under the age of 45.

“We need to reevaluate how we’re providing the care and make sure we can keep people there when they’re there,” LaRochelle said.

Even at just 3 in 10 patients, Massachusetts was likely offering better opioid medication treatment than many states as of 2014. That’s because 97 percent of the state’s residents have health insurance, the highest rate in the country. In many parts of the U.S., it’s difficult to find someone who will prescribe a patient methadone or buprenorphine.

“We just still have overwhelming stigma for patients with the disease of addiction,” said Sarah Melton, a professor of pharmacy practice at East Tennessee State University.

Volkow of NIDA is alarmed by one other finding. Thirty-four percent of patients receive at least one prescription for an opioid and 26 percent were prescribed a benzodiazepine during the 12 months after their overdose.

“This indicates that guidelines cautioning against prescribing opioids and their co-use with benzodiazepines are not being followed,” Volkow wrote.

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

Move over Cheetos. More fresh produce comes to Lawrence, Massachusetts bodegas.

A Bodega from Samuel R. Mendez on Vimeo.

This fun video came up during a search for a Metro story in this morning’s Globe.

LAWRENCE — Bodegas are an integral part of Latino community life in this racially and culturally diverse city of more than 80,200. There are at least 85 such sundry shops in an area spanning just a little more than 7.4 square miles.

But while Lawrence’s bodegas offer a wide variety of food from South and Central America, fresh fruits and vegetables have long been absent from local shelves.

Because of their small size, many bodegas don’t have the means to buy or store fresh produce. As a result, many of the city’s poor who don’t have a car to reach the few supermarkets that are on the edge of the city suffer from a dearth of healthy food options. More than 45 percent of children in the Lawrence school district were overweight or obese, according to a 2010 report by the state Department of Public Health, likely from unhealthy or unbalanced diets.

To combat the problem, Lawrence General Hospital and the city started a program called Healthy on the Block/Bodegas Saludables.

The Lawrence Eagle also covered the program.  

LAWRENCE — Cesar Checo opened the corner store at Lawrence and Park streets in 2007. Over the past few years, he’s made an effort to offer more than plantains and rice to his customers.

He has grown his bodega into more of a full service grocery store, providing fresh fruits and veggies to the neighborhood.

His El Mello Supermarket was recognized recently by city officials for Checo’s participation in the city’s Healthy on the Block/Bodegas Saludables program. The program provides bodega owners capital and guidance in a push to bring more healthy foods to Lawrence residents.