Nicky Mehtani

When my Medicaid patients learn that I study the role of psychedelic therapies in SUD Tx, they often ask when they'll be available. The answer: it depends. Grateful to share this @JAMANeuro perspective on aligning psychedelics research with health equity. jamanetwork.com/journals/jaman…

Written by my amazing friend and @OslerResidency co-ACS Dr. John Woller, one of the very best doctors and educators I know. Amidst his family’s grief, he is still working to dispel myths about fentanyl exposure 🥺 nytimes.com/2024/08/04/opi…

Noah Bush, 8 years old, was found drowned in Jesup, Georgia in May 2024. He went out to play with neighborhood kids & never came home. After finding his body in a small body of water the sheriff’s office immediately announced it was accidental & for two months they did nothing.

Our latest pub explores how psilocybin therapy may reduce HIV-related shame, a factor contributing to substance use and Tx challenges. While further research is needed, these data suggest possible new directions for HIV care. nature.com/articles/s4159… #HIV #addiction #psychedelics

Residency interviews are really the original ERAS tour

Amid recent policies further criminalizing poverty, cautiously optimistic about our @sf_dph Street Med program: long-acting injectable antiretrovirals show promise for people experiencing homelessness with or at risk for HIV. Read more in @pozmagazine: poz.com/article/longac…

Sharing a little morsel of a paper that I am excited abt bc it might represent a new way to measure success in SUD research one day. Hair testing to measure past month substance use and eventually🤞🏽quantify use (e.g., measure REDUCED use not just abstinence)

The core problem

🙏Incredibly grateful for the extraordinary @sf_dph nurses, health workers, and providers who continue to make this program possible and to @ucsf_hividgm collaborators for supporting this endeavor + showing us the way. @doctorajoanna @MonicaGandhi9 @ucsfdgimzsfg @ucsfbhhi (4/4)

💡Takeaway: Feasible implementation of LA ARVs for vulnerable populations requires a supportive environment, structure, multidisciplinary collaboration + (ideally) mobile outreach capacity. While risks exist, benefits for patients facing structural barriers can be dramatic. (3/4)

🌟Excited to share our recent @JAIDS article detailing the implementation of long-acting injectable ART & PrEP at a low-barrier @SF_DPH clinic for #PWUD & #PEH--in whom we have seen tangible benefits of these novel meds in treating + preventing HIV. (1/4) journals.lww.com/jaids/abstract…

a personal update: I recently signed onto my 1st faculty role at a hospital I’ve admired since a kid. Grateful for the chance to delve into research close to my heart and work w patients + colleagues who inspire. Thanks to all who've been part of this journey 🙏🏾🙂 @ucsfdgimzsfg

@fnalvarez For real. But, also… 2 pills TID?! 🤨 hard to imagine anyone really thought this through..

Wonder how many patients have stopped taking acamprosate because it’s dosed as 666mg? Couldn’t they have used 667?

Insurance companies have weaponized the prior authorization process, reports this @nytimes video op-ed This delays or stops care 1 in 3 doctors assert such delays have caused death or harm to patients Doctors’ offices have to hire staff purely to handle prior authorization battles nytimes.com/2024/03/14/opi…

DoxyPEP: Strategy by which men-who-have-with-men (MSM) & transgender women can take doxycycline as post-exposure prophylaxis after sex to prevent syphilis & chlamydia (gonorrhea needs vax). Astounding city-wide data from San Francisco -50% drop in both with DoxyPEP guidance.

BREAKING: Compassion clubs could be the solution we’re looking for! Long 🧵incoming… This is BIG NEWS! When I talk about the need for a regulated drug supply, people always ask me what widespread distribution of safer drugs could look like. Would we sell measured doses of clean cocaine, heroin, fentanyl, meth at a corner store, with only ID requirements to stop kids from trying them? (Or “hand out fentanyl to children” as critics like to claim?) NO, OF COURSE NOT. These are powerful and dangerous substances. Would we sell them at government distribution branches, like alcohol, and collect high taxes to fund prevention, treatment and recovery? Maybe, although the risk of attracting new users seems high (but it would also help prevent deaths of recreational drug users). One model that has great promise, and worked for cannabis before it was legalized, is the compassion club model. Access is membership-only for people with diagnosed substance use disorder. A variety of clean, unadulterated drugs that meets members’ needs is sold to them in measured doses. The club provides additional harm reduction services like clean supplies and supervised consumption. There’s little risk of children accessing the club or the drugs. There was only one compassion club operating like this in B.C., run by DULF in the DTES for just over a year. Unfortunately, it was raided and shut down last fall after a series of politically motivated accusations by MLA @ElenoreSturko (who ironically, is BC’s shadow minister for Mental Health & Addictions 🙄) But at least we now have academic research from its operation that shows a compassion club model CAN WORK! 🎉🎉🎉 A new peer-reviewed study by DULF and researchers from BCCSU and UBC — published in the International Journal of Drug Policy — found: ▶️ No one died of drug poisoning while they were participating members of the club. 👊🏼👊🏼 ▶️ Non-fatal drug poisonings were cut in half 👊🏼👊🏼 ▶️ Non-fatal poisonings involving naloxone were reduced by nearly two-thirds.👊🏼👊🏼 About half the members admitted to sharing their drugs with non-members at least once during the 12-month study period. (This is the evil “diversion” of CLEAN DRUGS (that contain no FENTANYL, XYLAZINE & BENZOS) so often blamed for the entire TOXIC DRUG crisis, which is totally illogical … but I digress). The reasons they shared included: ▶️ The non-member they shared drugs with was in pain or withdrawal ▶️ The non-member was unable to access a safe supply ▶️ To help a friend/acquaintance/partner be safe Sounds like more memberships were needed. In less than two weeks, on March 7 & 8, there will be a judicial review of Health Canada’s 2022 decision to deny DULF the exemption to the Controlled Drugs and Substances Act, which would allow them to operate a compassion club without breaking the law. Fingers crossed the court understands the issue and agrees there is a need. STAY TUNED! Link 🔗#fig0001" target="_blank" rel="nofollow noopener">sciencedirect.com/science/articl… #ToxicDrugCrisis #HarmReduction #SaferSupply #DULF #CompassionClub #BCpoli #CanPoli

Circling back to @LondonBreed's Prop F because <excuse my french but> WTF: 1. Data do not suggest compulsory treatment is effective. ncbi.nlm.nih.gov/pmc/articles/P… 🙏 @chngin_the_wrld & team 2. Fine, you don't like data or fair, these are heterogeneous studies. Stick w/me.. 🧵1/4

#BREAKING: New research on involuntary treatment for Substance Use Disorder finds forcing people into treatment to promote abstinence … DOESN’T WORK. Within the first two months after discharge, 96.4% of the 1,083 participants had relapsed. Recovery is HARD. For treatment to work, you have to want it. I went to treatment and recovery voluntarily more than 12 times, it took me roughly 26 years to accomplish my first year of sobriety … and I relapsed again after that. Lucky for me, the drugs were not as contaminated, unpredictable and deadly as they are today. So I got that time I needed to figure it out! Treatment and recovery programs are crucial, but they can’t be forced and they aren’t the only solution. Read the research here 🔗: sciencedirect.com/science/articl… #BCpoli #ToxicDrugCrisis #HarmReduction #Treatment #Recovery

Rain & Cold forecasts have triggered Weather protocols … 1/19 - 1/23 these shelters will be accepting walk-ins: