maintains its buy recommendation
Wednesday, January 10, 2024
Biotech Gets Creative to Avoid Bankruptcy in 2024
A total of 41 companies declared bankruptcy in 2023, according to SEC filings, an all-time high. And this is far from the only indicator of the industry’s poor financial conditions. The biotech industry is grappling with its worst bear market in recent memory, marked by challenges in obtaining fresh capital and cost-cutting measures such as layoffs.
In such a dreary funding climate, experts spoke with BioSpace about a paradigm shift in financial strategies, with increased use of royalty financing, spun-out assets and venture debt, among other nontraditional sources of cash.
There is a need to reevaluate conventional deals where companies sell common stock at market price or at a slight discount because “if you don’t and don’t get realistic, you’re going out of business; you’re going to run out of money,” said Ira Leiderman, managing director of healthcare at investment banking firm Cassel Salpeter & Co.
Growth in Royalty Financing
One of the alternatives that companies are increasingly turning to is royalty financing—funding based on future revenue-sharing agreements. Royalty financing looks attractive to companies, generally speaking, because these are non-diluted sources that do not affect their equity value, experts explained to BioSpace. In contrast, venture capital funding, angel investors, IPOs, convertible notes, stock options and warrants, rights offerings and secondary offerings all typically dilute equity.
Royalty financing has “carved out its place in the market,” said Brad Sitko, chief investment officer at XOMA, because “you’re selling economics,” not shares.
Historically, royalty financing has been dominated by three firms—Royalty Pharma, HealthCare Royalty Partners and Blackstone. They made up an average of 70% to 80% of the royalty dollars over the last couple of years, said Cody Powers, a partner and principal of portfolio and pipeline at management consulting services company ZS Associates. But now, more and more companies are adopting royalty financing. “There are more players now, and even more people are trying to get in,” Powers told BioSpace.
There are risks, however. If the company gives up too much upfront in a royalty deal and receives too little of a product’s revenue down the line, it can have serious financial consequences. “But given the choice between developing nothing and developing something, a lot of companies right now are just saying, ‘We’ll just deal with lower profitability,’” said Powers, adding that “it’s hard to imagine” the royalty financing space would not continue growing moving forward.
Ravi Samavedam, chief innovation officer at quality and compliance solutions company Azzur Group, also noted a growing trend among early-phase startups constrained by limited capital: offering future royalties in exchange for a firm’s services. This allows them to conserve funds for scientific endeavors, with the expectation of one day making payments based on the revenue generated by their assets.
Yet Leiderman cautions that licensing deals, including royalty financing, can take too long to help the company stay afloat. “Doing a licensing deal takes six to nine months minimum,” he said. “If you’re relying on that to pay the rent and make payroll, it’s pretty dangerous.” So, in some cases, companies may want to consider other options, he added.
Alternative Funding Strategies
Recent layoffs have depleted companies’ expertise, leading to a trend of transferring less mature programs to other entities through licensing agreements or partnerships, Samavedam told BioSpace. Besides royalty funding, companies can consider mergers and reverse mergers, or sharing the license with another firm to co-market therapies in specific geographic locations.
Another funding option is venture debt. Instead of selling ownership stakes in exchange for capital, companies access non-dilutive financing through VC loans. This, however, can be challenging for biotechs without a clear repayment plan, according to Sitko.
Grant financing is yet another avenue, but its unpredictability make it an unreliable solution for many companies, Sitko said.
Lain Anderson, managing director and partner at strategy consulting firm L.E.K. Consulting, also brought up the hub-and-spoke model, which he called “an emerging trend.” This approach involves dividing a portfolio into distinct entities and fundraising for them separately, he said. It caters to investors who may prefer to invest in specific assets, seeking transparency about the allocation of their funds within the portfolio.
In general, Sitko said the right advice to companies is to use the fishing analogy and have as many lines in the water as possible. “You don’t know what is going to turn over and be the positive financing event you’re seeking and will allow you to continue.”
Keep Valuations Reasonable
Whether pursuing traditional or alternative investments, appropriate company valuations are important, experts told BioSpace. A company’s valuation directly influences the terms on which it can secure funding, and many companies these days make the mistake of overvaluing their worth, said James Cassel, chairman and co-founder of Cassel Salpeter.
“It may be that the seller has to give some consideration to taking earn-outs, milestone payments and other types of structures because what they really need is the buyers coming into the finance process moving forward, and some people are unrealistic about this until it’s too late,” Cassel told BioSpace. “No one has gone out of business from dilution, and it’s better in many cases to keep a smaller part of your company funded than own 100% of your company that goes out of business.”
https://www.biospace.com/article/biotech-gets-creative-to-avoid-bankruptcy-in-2024/
Becerra the Invisible
He’s been called the “invisible” secretary. So far removed from the White House sphere of influence that he’s rarely spotted there, even at health care events. Once, officials openly discussed who might be better for the job.
Now, however, health secretary Xavier Becerra is making inroads with the president’s closest advisers. After years on the outs with Susan Rice, Biden’s first domestic policy advisor, Becerra has weekly meetings with her replacement, Neera Tanden, people familiar with their discussions said. He also is speaking regularly with White House Chief of Staff Jeff Zients, according to people who know his schedule.
The looming question is whether, with just a year left in Biden’s first and potentially only term, he’ll have enough time to put his official stamp on what was once considered one of the most consequential Cabinet positions.
It may be too late. Becerra has not been publicly identified with many of the president’s health care accomplishments. He didn’t attend an August event celebrating Medicare’s new power to negotiate drug prices, a packed East Room celebration with Vice President Kamala Harris, Medicare Director Meena Seshamani, and Robert Califf, head of the Food and Drug Administration, all present. He’s ceded the spotlight on Democrats’ politically popular efforts to protect abortion rights to Harris.
Becerra also wasn’t part of White House talks to launch a new phase of Biden’s most personal project, the Cancer Moonshot, three people familiar with the planning said. And when the president touted a new plan to require fair pricing for government-funded medicines this December, Becerra did not issue a statement and was not part of press events.
It’s unclear what legacy Becerra will leave on the nearly $130 billion agency he leads, either, several government officials and outside advocates told STAT. That is confounding to many people who recall that when Becerra was California attorney general, he took a forceful stand on issues like abortion rights. As a member of Congress, he’s credited with helping shape the Affordable Care Act, and then defending it from Republican attacks. Yet as health secretary, several current and former government officials — including many Democrats — said it was hard to point to any obvious wins.
“Certainly from a public profile point of view he’s been a major disappointment,” said Lawrence Gostin, a public health law professor at Georgetown University. “He’s a very prominent Latino leader, and he was well placed to really shine during Covid, monkeypox, and other health crises. He was very silent during those crises and when he did speak, he didn’t seem to have a good, enormous grasp of the medical and scientific and public health issues.”
Gostin tempered his remarks by noting that Becerra’s policymaking behind the scenes as HHS secretary is extensive, especially on reshaping health prices and coverage.
An HHS spokesperson emphasized a string of Becerra’s accomplishments as secretary, including his work to ensure access to Covid vaccines and the launch of the 988 mental health hotline.
“There’s rhetoric — what people say you’ve done, and then there’s your record — what you’ve actually done. If you look at Secretary Becerra’s robust record, you will see he has accomplished a lot for the American people, including people who are underserved and under-resourced — all while doing national and local interviews in both English and Spanish and traveling across the country to talk with people most impacted by the Department’s work,” said Kamara Jones, the spokesperson.
“Secretary Becerra can either focus on beltway politics or the health and wellbeing of the nation. If you consider his many accomplishments as Secretary and that he is one of the most traveled cabinet secretaries during this Administration, it is clear he is focused on the health and wellbeing of the nation,” Jones added.
It’s not as though he hasn’t done anything, Becerra’s supporters also emphasize. It’s more that he hasn’t been successful at earning or taking credit for his accomplishments, either publicly or with the White House, until recently.
Becerra himself cites record ACA enrollment as one of his biggest wins, and he wants to solidify that coverage even as potential subsidy cuts for many enrollees loom. When asked what he believed his legacy as secretary would be, he pointed to that and spelled out an aspiration for even more solidified health care coverage.
“I would like to see us make it so that everyone equates Obamacare, the Affordable Care Act marketplace, with good health care,” he told STAT, adding that the “ACA becomes like Medicare, Medicaid, and Social Security. They are part of the fabric of life in protecting your health.”
Becerra’s promotion of Obamacare comes against the backdrop of calls from GOP presidential candidates, including former President Trump and Florida Gov. Ron DeSantis, to dismantle the law. Congress has also extended significant ACA subsidies through 2025, but there is no guarantee they will continue, particularly if a Republican wins the White House and congressional control turns over.
His success or failure as health secretary — and his impact on Biden’s broader health care achievements — could be a factor in a 2024 presidential election that will put a spotlight on issues like abortion, high health care costs, and fallout from the Covid-19 pandemic. Whether he has the White House’s ear on these subjects will also determine exactly what legacy he leaves — the latter remains an open question, according to more than a dozen people who spoke with STAT, many of whom worked with Becerra at the Capitol, in California, or in the Biden administration itself.
A quick fade into the background
Almost immediately, Becerra had a stumbling start with the White House.
Within weeks of his confirmation, he landed in a tete-a-tete with White House Domestic Policy Adviser Susan Rice, according to a book published in September and confirmed to STAT by two people. In a phone call with dozens of other officials present, Rice pressed the secretary to loosen certain rules to help Border Control officials deal more effectively with the crush of migrant children at the border. Becerra wanted a written order from Biden before he moved to change anything — an idea Rice sharply shot down.
Becerra seemed to fade into the background from there, three sources said. He wasn’t a major figure in the Biden administration’s Covid-19 response, yielding frequently to top infectious disease official Anthony Fauci, then-Covid-19 coordinator Jeff Zients and then-Centers for Disease Control and Prevention Director Rochelle Walensky.
His first appearance at a White House press briefing was a full year into his tenure — so late, compared to other cabinet secretaries, that reporters were asking when they might see him there.
“The White House really paid no attention to him,” for the first two years, said a former senior Biden official.
In fact, some White House officials seem to have a closer relationship with Becerra’s deputy, Admiral Rachel Levine. Her official remit is mental health issues but she became integral to shifting budgets so that federal programs like free Covid tests can continue, one person familiar with the dynamics said. Her intricate knowledge of the budget details was vital as congressional relief funds dried up, the person said.
Becerra, in an interview with STAT, said his relationship with White House officials has “evolved” over the past two and a half years. “We try to make sure that we’re doing what the president asked. The White House gets to propose, it’s our job at HHS to execute.”
Jones, the HHS spokesperson, added that Becerra is “a team player who prioritizes staying in sync with the White House and playing whatever position the President needs him to play. If furthering the President’s agenda means he needs to be on TV, he’s on TV. If it means he needs to be on the road, he’s on the road. If it means he needs to meet with an agency to ensure they’re implementing a policy as intended, he’s meeting with the agency.”
When it comes to media and outreach, the secretary largely stuck to constant travel around the country to champion Biden priorities. He traveled to more than half the U.S. states and India in 2023 alone, heading from Wisconsin to Arizona, South Dakota, and California to champion Biden’s efforts on drug price negotiation, mental health care access, and other policies.
Democratic lawmakers praised that travel as an important effort to highlight Biden priorities and reach out to communities about federal health programs. But others question if it is the best use of a Cabinet member’s time, considering that polls show the president had not made substantial public inroads with his health policies.
For instance, despite the administration’s moves to cap insulin costs and negotiate drug prices through the Medicare program — two crowning accomplishments under Becerra’s tenure and focal points in his travel events — only 30% of Americans said last year that the president has made progress lowering costs.
“Basically, the majority of Americans do not believe that Biden’s done anything about drug prices,” said Robert Blendon, a Harvard T.H. Chan School of Public Health professor who tracks voters’ sentiment on health care and other policies. “The president has not been seen as a great communicator of what they’ve accomplished.”
That’s where someone like the highest-ranking health official could be key.
“It’s not getting him slightly more likable or knowable. It’s having somebody … repeat over and over again, ‘You said drug prices were really a problem — we’ve lowered them,’” Blendon said.
He’s not playing that role on abortion, either — though he could have. Before President Biden tapped him for the Cabinet, Becerra was known as something of a fighter. He took on anti-abortion activists, high drug costs, and then-President Trump’s agenda as California’s attorney general, suing the federal government 110 times.
“We’re not looking to pick a fight, but we’re ready for one,” he said during his California confirmation hearing for the AG role.
But as the Biden administration has sought to frame itself as a protector of abortion rights, the face of that fight has almost entirely been Harris, who has held campaign rallies and White House roundtables and made the issue a cornerstone of her 2024 election message. Harris was California attorney general before Becerra and initiated several of the suits and complaints he pursued.
That doesn’t mean the secretary has been inactive, abortion advocates argue. His agency issued guidance shortly after Roe v. Wade fell, underscoring physicians’ obligation to treat people in emergency situations including abortion. HHS is also barreling toward a U.S. Supreme Court battle this summer over whether the abortion pill mifepristone, which accounts for more than half of the country’s abortions, can remain on the market.
“Anyone who holds that office has to bring so many different skill sets to it,” said Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute, a research and advocacy group focused on reproductive rights. Becerra brings the legal chops, but communicating progress, even for advocates, has always been a “challenge,” Friedrich-Karnik said.
“The details matter and the specifics matter … translating that to the public can be hard,” she said. “It behooves the administration to continue to prioritize and work really hard to explain to the public what it is they’re doing.”
At HHS, a hazy legacy
Becerra’s generally low profile means he has not been in Washington much. For at least the first few years of the administration, he was not in the room with White House officials shaping the president’s signature policies, multiple people familiar with the dynamic said. That makes it hard to claim any of Biden’s accomplishments as his own, they said.
In contrast, other health secretaries have planted their legacies on signature issues. Trump’s HHS secretary, Alex Azar, made rules dismantling the pharmacy benefit manager system — in a bid to lower drug prices — a top priority, regardless of Congress’ freeze on the issue. Obama HHS Secretary Katherine Sebelius became the face of ACA implementation and the eventual rollout chaos.
“Azar, he’s probably the most parallel figure to Becerra in the sense that he’s a lawyer. He’s also a cultural warrior, on the other side. But he had absolute command from the start,” said Gostin.
Becerra wasn’t part of the discussion about relaunching Biden’s Cancer Moonshot, three people familiar with discussions told STAT. Instead, it was White House aides and outside advisers who took on the effort to reframe one of Biden’s most personal missions, almost entirely channeling reworked projects and goals to a new agency that the president pushed to found, the Advanced Research Projects Agency for Health.
He also has been missing from Biden’s latest push for the National Institutes of Health to license patents for government-funded research to generic drugmakers, an attempt at cheaper medicine that the pharmaceutical industry and even some NIH alums have questioned. When Biden himself made a rare appearance at the NIH campus in December to champion the initiative, Domestic Policy Advisor Neera Tanden and new NIH director Monica Bertagnolli were by his side. Becerra was not.
Yet the agency under Becerra has lodged a series of accomplishments on health cost and coverage fronts, even if they are not translating to the broader public, said Judy Baker, an Obama HHS official and NYU policy professor.
“HHS has traditionally had less success with communicating to the public what they’re doing,” Baker said. “A good communication plan to the public would be a thing they should prioritize.”
Even on Covid-19, the secretary can count some wins: He met with Pfizer officials last year to strike a deal for Covid-19 treatment Paxlovid that resulted in a buyout agreement that would let officials return unused doses for new ones, assuring free coverage for government insured Americans through 2024.
Becerra, for his part, sees himself as a “manager” or “steward” of these myriad issues handled by the farm of subagencies under his purview, several people told STAT. That oftentimes means letting Medicare and Medicaid officials take the lead on defending major drug price reforms and explaining coverage changes, or tapping other high-ranking officials like Levine to be the public face of efforts to boost mental health care and protect transgender Americans’ rights.
“Obviously the fact that today there are still more Americans who have insurance than before than any other previous administration — more than 300 million people — that’s an accomplishment,” Becerra told STAT.
Yet he acknowledged that many Americans won’t see the effects of one of his agency’s biggest efforts — lowering drug costs — just yet.
“We want them to know because we want them to be able to take advantage of it. And so we’re gonna get out there and talk about all of those very important things,” he said.
Becerra also does maintain influence on Capitol Hill, even if not with the White House. He has strong relationships with the Congressional Hispanic Caucus, a powerful base of influence particularly as Biden and other presidential candidates head into the 2024 election.
“It’s really helpful when you have someone there [as HHS secretary] who understands the impacts, especially the negative impacts to our communities, of policies like people getting kicked off of Medicaid. It makes a huge difference, having a seat at the table,” said Rep. Nanette Barragán (D-Calif.), chairwoman of the caucus.
Asked about whether the White House has leveraged Becerra well as one of the most prominent cabinet members, Barragán sidestepped the question, replying, “We’re really proud that he is a former colleague of ours and representing our communities.”
Much of Becerra’s work has also been accomplished behind the scenes, supporters say. Becerra met with Pfizer officials to strike a deal for Covid-19 treatment Paxlovid that resulted in a buyout agreement that would let officials return unused doses for new ones, assuring free coverage for government insured Americans through 2024.
“Whenever I ask for a phone call, or he asks for a phone call, it’s quickly done,” said Richard Neal (D-Mass.), Becerra’s former colleague on the Ways and Means Committee and the current highest-ranking Democrat. “If you move from the legislative branch to the executive branch, there’s gonna be differences. You also work for the President.”
Becerra has visited Democratic Rep. Adriano Espaillat’s New York district “a bunch of times,” the congressman told STAT. “He’s someone that brings not just the budgetary regulatory experience to the job, but brings a level of empathy for health care that I think was much needed in the department.”
The door wedges open — but is it enough?
There has been a shift in Becerra’s favor in recent months, multiple people familiar with HHS and White House discussions told STAT. There are new people in the White House and at HHS, including a new assistant secretary for public affairs, seasoned communications expert Jeff Nesbit.
And Becerra meets at least once a week with Rice’s replacement, Tanden, he said. There are formal weekly meetings and touching base “every week on a less formal basis.”
The secretary “has a big heart and has been an incredible partner to improve health care for all Americans,” Tanden said in a statement. “I am proud to work alongside him as he continues to advance President Biden’s key priorities” including health care coverage, mental health access and the opioid crisis response, she said.
He also is speaking regularly with White House Chief of Staff Jeff Zients, a returnee to the administration from his Covid-19 task force days, according to two people familiar with their discussions. Zients’ relationship with Becerra started out much like Rice’s, with neither corresponding regularly with the HHS secretary in the early months of the crisis, one of those people said. The dynamics changed after Zients returned in a different role, they added.
“He often invites us to lunch,” said Becerra. “The communication is fluid, but it’s constant … it’s a good ebb and flow. It’s a relationship that evolves given the situation.”
That’s helped change his presence and visibility with the White House. Becerra spoke with Tanden at a December event heralding community health workers and applauding American Rescue Plan funding for their support. He also appeared beside the president at a Nov. 14 event on women’s health and attended a state dinner with the Australian president in October. The president applauded his work on insuring Americans during a September reception for Hispanic Heritage Month.
“At the end of the day, if we can say at the same time that we have lowered costs [while providing] better care for more Americans, that means we will have delivered on the president’s promise,” said Becerra. “And that’s our job to execute.”
https://www.statnews.com/2024/01/09/xavier-becerra-hhs-secretary-legacy/
Alopecia on the Rise After COVID, Study Suggests
The incidence of alopecia areata significantly increased after COVID-19, a nationwide study involving more than half a million South Koreans found.
In a propensity score-matched analysis, incidence of the autoimmune form of hair loss was 82% higher for individuals with versus those without a prior COVID infection (43.19 vs 23.61 per 10,000 person-years; adjusted HR 1.82, 95% CI 1.60-2.07), reported Jin Park, MD, PhD, of Jeonbuk National University Medical School in Jeonju, South Korea, and colleagues.
Higher incidence was seen in all groups older than 20 years, with a greater risk observed both in women and men, they detailed in a JAMA Dermatology research letter.
The study also revealed an increased incidence of telogen effluvium -- rapid hair loss triggered by stress or other changes to the body -- among the cohort with COVID compared with the control group (adjusted HR 6.40, 95% CI 4.92-8.33).
"These findings support the possible role of COVID-19 in AA [alopecia areata] occurrence and exacerbation, although other environmental factors, such as psychological stress, may have also contributed to AA development during the pandemic," Park and co-authors added. "Plausible mechanisms of AA following COVID-19 include antigenic molecular mimicry between SARS-CoV-2 and hair follicle autoantigens, cytokine shifting, and bystander activation."
Alopecia areata "occurs in susceptible individuals by environmental triggers, such as viruses, vaccinations, and psychological stress," the researchers said, adding that while reports of documented new onset, exacerbation, and recurrence of alopecia areata after COVID have been increasing, evidence linking alopecia areata to COVID has been limited.
For their propensity score-matched study, the authors used data from the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service cohort from October 2020 through September 2021. The cohort included 259,369 patients with COVID and 259,369 patients without COVID. Patients were matched along demographic characteristics and comorbidities.
Looking at clinical subtypes, incidence of patchy alopecia areata or alopecia totalis and alopecia universalis (AT/AU) were higher in patients with COVID, at 35.94 and 7.24 per 10,000 person-years, respectively, as compared with 19.43 and 4.18 per 10,000 person-years among controls. Meanwhile, the prevalence of alopecia areata and AT/AU was 70.53 and 12.39 per 10,000 person-years in the COVID group versus 52.37 and 8.97 per 10,000 person-years in controls.
"During the study period, the age- and sex-adjusted incidence and prevalence of AA [alopecia areata] and AT/AU in COVID-19-infected patients were considerably higher than in the prepandemic period in Korea, in which incidence and prevalence of AA and AT/AU remained constant from 2006 to 2015," they wrote.
Park and team acknowledged "potential detection or misclassification bias" in their study, despite using validated sensitivity analyses with several matching variables. They said that "further studies are necessary to validate the association between different populations and elucidate the causal relationship between the two conditions."
Disclosures
This study was supported by grants from the National Research Foundation of the Korean Government and a grant from the Ministry of Health and Welfare, Republic of Korea.
The authors reported no conflicts of interest.
Primary Source
JAMA Dermatology
Source Reference: Kim J-S, et al "Risk of alopecia areata after COVID-19" JAMA Derm 2024; DOI: 10.1001/jamadermatol.2023.5559.
https://www.medpagetoday.com/infectiousdisease/covid19/108202
Trends in Incident Prescriptions for Behavioral Health Medications in the US, 2018-2022
Grace Chai, PharmD, MPH1Jing Xu, PhD, MA1Sonal Goyal, PharmD, MPH1; et al
doi:10.1001/jamapsychiatry.2023.5045
Question How was the COVID-19 pandemic associated with trends in medication treatment initiation across various behavioral health conditions in the US?
Findings In this cross-sectional study of 105 500 490 prescriptions dispensed between April 2018 and March 2022 obtained from a US prescription database, trends in the number of incident prescriptions dispensed nationally for Schedule II (C-II) stimulant and nonstimulant medications for attention-deficit/hyperactivity disorder (ADHD) significantly increased during the COVID-19 pandemic, exceeding prepandemic rates, notably in young adults and women. Incident prescription trends for antidepressants, benzodiazepines, and buprenorphine for opioid use disorder did not significantly change.
Meaning The differential changes during the COVID-19 pandemic in incident prescription trends for ADHD, particularly for C-II stimulants, underscore the need for robust policies to address unmet needs while balancing public health concerns.
Abstract
Importance The COVID-19 pandemic reportedly increased behavioral health needs and impacted treatment access.
Objective To assess changes in incident prescriptions dispensed for medications commonly used to treat depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and opioid use disorder (OUD), before and during the COVID-19 pandemic.
Design, Setting, and Participants This was a cross-sectional study using comprehensive, population-level, nationally projected data from IQVIA National Prescription Audit on incident prescriptions (prescriptions dispensed to patients with no prior dispensing from the same drug class in the previous 12 months) dispensed for antidepressants, benzodiazepines, Schedule II (C-II) stimulants, nonstimulant medications for ADHD, and buprenorphine-containing medication for OUD (MOUD), from US outpatient pharmacies. Data were analyzed from April 2018 to March 2022.
Exposure Incident prescriptions by drug class (by prescriber specialty, patient age, and sex) and drug.
Main Outcomes and Measures Interrupted time-series analysis to compare changes in trends in the monthly incident prescriptions dispensed by drug class and percentage changes in aggregate incident prescriptions dispensed between April 2018 and March 2022.
Results Incident prescriptions dispensed for the 5 drug classes changed from 51 500 321 before the COVID-19 pandemic to 54 000 169 during the pandemic. The largest unadjusted percentage increase in incident prescriptions by prescriber specialty was among nurse practitioners across all drug classes ranging from 7% (from 1 811 376 to 1 944 852; benzodiazepines) to 78% (from 157 578 to 280 925; buprenorphine MOUD), whereas for patient age and sex, the largest increases were within C-II stimulants and nonstimulant ADHD drugs among patients aged 20 to 39 years (30% [from 1 887 017 to 2 455 706] and 81% [from 255 053 to 461 017], respectively) and female patients (25% [from 2 352 095 to 2 942 604] and 59% [from 395 678 to 630 678], respectively). Trends for C-II stimulants and nonstimulant ADHD drugs (slope change: 4007 prescriptions per month; 95% CI, 1592-6422 and 1120 prescriptions per month; 95% CI, 706-1533, respectively) significantly changed during the pandemic, exceeding prepandemic trends after an initial drop at the onset of the pandemic (level changes: −50 044 prescriptions; 95% CI, −80 202 to −19 886 and −12 876 prescriptions; 95% CI, −17 756 to −7996, respectively). Although buprenorphine MOUD dropped significantly (level change: −2915 prescriptions; 95% CI, −5513 to −318), trends did not significantly change for buprenorphine MOUD, antidepressants, or benzodiazepines.
Conclusions and Relevance Incident use of many behavioral health medications remained relatively stable during the COVID-19 pandemic in the US, whereas ADHD medications, notably C-II stimulants, sharply increased. Additional research is needed to differentiate increases due to unmet need vs overprescribing, highlighting the need for further ADHD guideline development to define treatment appropriateness.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2813980
Meta to hide self-harm, eating disorder content from teen users
Meta will restrict content related to suicide, self-harm and eating disorders from teen users as part of an update to youth safety and privacy policies, the company announced Tuesday.
The content restriction update expands on Meta’s policy that barred recommendations of content about suicide, self-harm and eating disorders in teen users’ reels and explore pages. Content about those topics will now be hidden for teens to view in their feeds and stories, even when it is shared by an account the user follows, according to Meta’s blog post.
If a teen user searches for terms related to restricted topics, they will be directed to expert resources for help.
As part of the update, Meta will also be placing all teen users into its more restrictive content control settings on Instagram and Facebook, according to the announcement. The setting was already in place for new teen users who joined the platforms and will now be expanded to teens already on the apps.
Meta will also roll out notifications with prompts that direct teens to update their privacy settings. Teen users will have the option to “turn on recommended settings,” which will automatically change their settings to restrict who can repost their content, tag or mention them, as well as to help them hide offensive comments and ensure only their followers can message them.
The update is Meta’s latest changes to settings for teen users after mounting scrutiny over how Meta and other tech giants are impacting children’s safety and mental health.
Later this month, Meta CEO Mark Zuckerberg is scheduled to testify before the Senate Judiciary Committee at a hearing on children’s safety along with the CEOs of TikTok, Discord, Snap and X, the platform formerly known as Twitter.
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