Recent IHPS Work in Substance Use and Mental Health

Laura Schmidt, PhD, MSW, MPH and Dorie Apollonio, PhD, MPP, currently mentor Ellie Matthay, PhD in her research looking at cannabis control policies.  Currently, 38 states allow medical cannabis use and 19 states allow recreational cannabis use.  The policies that affect public health regarding cannabis are significantly governed by local authorities and vary widely. Matthay, with Schmidt, Apollonio and colleagues researched the patterns of local cannabis control policies in California relative to socioeconomic and demographic characteristics. Their findings suggest there is potential for cannabis legalization to exacerbate longstanding racial/ethnic and socioeconomic inequities – with more bans on cannabis businesses located in areas with higher income and education levels and lower proportions of Black and Latino residents. Their findings also suggest that while local control of cannabis policies presents an opportunity to increase public health since the policymakers are more directly responsible to their constituents, in California the uneven local implementation of these policies may help explain why cannabis businesses are disproportionately located in low-income communities of color

Justin White, PhD is doing work the work on minimum floor price laws (MFPLs) for tobacco products, a policy that complements tobacco taxation and other pricing regulations. Tobacco minimum floor price laws (MFPLs) are a non-tax price policy that set a price below which tobacco products cannot be sold, thereby raising prices. Increased prices of tobacco are an effective deterrent to tobacco use.  He has worked with Alameda County Public Health Department, in collaboration with then-postdoc David Boettiger, to do a microsimulation of the anticipated effects of an MFPL in Oakland, CA. Oakland subsequently used that evidence to pass an MFPL ordinance.  

Jayme Congdon, MD, MS is working with pediatric colleagues in Santa Clara County on the implementation and evaluation of a new buprenorphine treatment program for adolescents with opioid use disorder (OUD), which was developed in response to a surge in pediatric overdoses and a severe shortage of youth treatment access. Program participants initiate buprenorphine in the inpatient pediatric unit during an approximately 1-2 day hospital stay and are then linked to outpatient or residential treatment upon discharge. After about one year and 50 admissions for youth ages 12-21, over 90% completed buprenorphine induction, and about three-quarters were successfully linked with ongoing treatment after discharge. A manuscript of these findings and the inpatient induction protocol are in press at Hospital Pediatrics. She and her colleagues are continuing to follow patients to assess longitudinal clinical outcomes and are also working with neighboring counties developing similar programs.

One of the barriers that arose in the Santa Clara OUD treatment program was the need for parental consent for minors, per California law. While pediatric providers always make every effort to engage caregivers, a number of the patients <18 who present for treatment do not have an available or supportive caregiver to consent (e.g., unhoused youth). Last Spring, Congdon reached out via Twitter DM to newly sworn-in California Assemblymember Matt Haney about this barrier to care, and he immediately responded that he wanted to help. After working with his team and other experts for several months, there is now a draft bill that would allow minors 16 and up to consent to OUD treatment with buprenorphine. Assemblymember Haney plans to introduce the bill in the next legislative session.

Mandana Khalili, MD is looking at unhealthy alcohol use in hepatology. In the “Impact of the COVID-19 pandemic on patient outcomes, telehealth care delivery, and treatment for unhealthy alcohol use in vulnerable patients with advanced liver disease across two healthcare systems (CovALD) study (R01AA029312)”, the principal investigators, Drs Khalili and Satre, and coinvestigators test a stepped care treatment model for unhealthy alcohol use within the hepatology specialty care setting across Zuckerberg San Francisco General Hospital and two VA healthcare systems (San Francisco and Palo Alto) serving vulnerable populations in the Bay Area. This is a multidisciplinary collaboration of experts in liver disease, health disparity, mental health and addiction medicine that seeks to address our gaps in knowledge of optimal treatment options and to enhance linkage to alcohol treatment services in patients with liver disease.

Christina Mangurian, MD, MAS is looking at mental health care delivery by pediatric primary care providers during the Covid-19 pandemic. Due to a national shortage of child and adolescent psychiatrists, pediatric primary care providers (PCPs) are often responsible for the screening, evaluation, and treatment of mental health disorders. COVID-19 pandemic stay-at-home orders decreased access to mental health care and increased behavioral and emotional difficulties in children and adolescents. Despite increased demand upon clinicians, little is known about mental health care delivery in the pediatric primary care setting during the pandemic. This focus group study explored the experiences of pediatric PCPs and clinical staff delivering mental health care during the pandemic. Transcripts from nine focus groups with San Francisco Bay Area primary care practices between April and August 2020 were analyzed using a thematic analysis approach. Providers expressed challenges at the patient-, provider-, and system-levels. Many providers reported increased patient mental health symptomatology during the pandemic, which was often intertwined with patients' social determinants of health. Clinicians discussed the burden of the pandemic their own wellness, and how the rapid shift to telehealth primary care and mental health services seemed to hinder the availability and effectiveness of many resources. The findings from this study can inform the creation of new supports for PCPs and clinical staff providing mental health care.

Matt Tierney, MS, NP, FAAN is the Clinical Director of Substance Use Treatment and Education for the Office of Population Health at UCSF Health. His decades of work as an educator and clinician have helped improve access to mental health and substance use treatment. Matt’s regional and national teaching focuses on preparing and expanding the interprofessional addiction treatment workforce and has included serving as content reviewer and teaching faculty for the federally-approved DEA waiver courses that prepare health professionals to deliver office-based opioid treatment (OBOT).  Since 2018 he has served as co-investigator and principle investigator on two SAMHSA grants at the UCSF Schools of Nursing and Medicine where he designed and delivered novel curricula that have prepared entry-level health professionals to deliver evidence-based substance use treatments.

A Fellow of the American Academy of Nursing, Matt serves on the Expert Panel on Mental Health and Substance Use Disorders, where he was lead author of a 2020 publication highlighting the progress made by the nursing profession in addressing substance use and offering policy recommendations to sustain and advance those efforts. At the invitation of the President of the National Academy of Medicine (NAM) in 2021 he co-authored an update on mental health and addiction policy priorities for the incoming Biden Administraiton as part of the NAM "Vital Directions" series.  Also in 2021, he co-authored two publications in the National Academy of Medicine’s Perspectives on the need for equitable expansion of OBOT.

Matt is a co-investigator with Susan Chapman, RN, PhD, FAAN, and Laura Wagner, RN, PhD, FAA on the R01 grant of Joanne Spetz, PhD that examines the effectiveness of federal and state policies in expanding the clinical workforce authorized to deliver OBOT via buprenorphine.