ICYMI: Telehealth prescribing extended

Patients who use telehealth to get controlleds will still be able to do that without an in-person visit, thanks to an agreement between the DEA and HHS. These “telemedicine prescribing flexibilities,” which started during the pandemic, will be in place at least through the end of 2025.

Our number 2 story

Background: Fecal microbiota transplants (FMTs) have been shown to be a disturbingly useful tool for fighting bacterial infections (looking at you, C. diff). It may even help with other conditions, from obesity to depression.

These are done, as Prince might say, ‘in through the out door’ via various techniques, none of which are appropriate for a family newsletter. And it comes with risk, notably that there might be pathogens in the donor stool.

But now a group of those shifty Danes think they’ve found a better way to do an FMT. They’ve managed to use fermentation to cultivate bacteria from feces — and the technique allows them to control which bacteria are grown.

Twist: They’re growing “bad” gastrointestinal bacteria; their plan is to kill those bacteria and leave only the bacteriophages that attack them. Then they’ll put those phages in a pill, which would kill the unwanted bacteria in a patient’s gut.

The long-term goal is for the treatment to evolve into a simple pill that can be prescribed by a doctor or found on a pharmacy shelf — tailored to individuals, but accessible to all.

Three bits of good news

… about drug overdose deaths

They look like they’ll end the year at the lowest level since the pandemic — and this year they’ve dropped for the first time in 5 years (for 12 straight months!), according to CDC data, thanks in large part to federal law enforcement intercepting the drugs. Fun fact: Despite what you might have heard, those drugs aren’t smuggled across the border — they’re shipped in through ports.

… about drug shortages

After hitting an all-time high of 323 meds in shortage, the number dropped to just 277 in the second quarter of this year, according to the American Society of Health-System Pharmacists and the University of Utah. That marks the second quarter in a row where active shortages have decreased.

… about STDs

The nationwide STD epidemic might finally be slowing. The number of sexually transmitted infections is down about 2% from 2022 to 2023. Hopefully it’s the start of a trend, rather than a single downward blip.

More than 2.4 million STIs were reported last year, compared to more than 2.5 million in 2022, with nearly half occurring in adolescents and young adults aged 15–24, according to a report by the [CDC].

Now it’s the carrots

Just as the nation is recovering from the deadly E. coli outbreak from McDonald’s, the CDC is reporting “a multistate outbreak of E. coli O121 infections linked to multiple brands of recalled organic whole bagged carrots and baby carrots sold by Grimmway Farms.”

Brands: 365, Bunny Luv, Cal-Organic, Compliments, Full Circle, Good & Gather, GreenWise, Grimmway Farms, Marketside, Nature’s Promise, O-Organic, President’s Choice, Raley’s, Simple Truth, Sprouts, Trader Joe’s, Wegmans, Wholesome Pantry

How ketamine works

It’s not news that ketamine can treat depression quickly — within hours in many cases. What’s eluded researchers is exactly how that happens. What’s ketamine doing in the brain?

Now biochemists at the University of Buffalo say they know.

Ketamine, they found, works on particular neurotransmitter cells called NMDA receptors. There are several kinds of these, but what the Buffaloians found is that ketamine works on some of them — only the ones that are active for longer periods. (Some are just intermittently active.) Drugs that target all the NMDA receptors, on the other hand, have all sorts of negative side effects.

“[Activating those receptors] results in an immediate increase in excitatory transmission, which in turn lifts depressive symptoms. Moreover, the increase in excitation initiates the formation of new or stronger synapses, which serve to maintain higher excitatory levels even after ketamine has cleared from the body, thus accounting for the long-term relief observed in patients.”

Figuring out ketamine’s mechanism, they think, might lead to even better quick-acting antidepressants.

Elsewhere: Baltimore does it again

Back in September, we told you how Baltimore scored big by opting out of the nationwide opioid settlement and suing drugmakers and distributors on its own. Welp, it did it again, this time scoring a $274 million jury verdict against AmerisourceBergen and McKesson.

But there could be more:

Circuit Judge Lawrence P. Fletcher-Hill scheduled an “abatement” trial in December. That proceeding determines how much the companies must pay to help Baltimore mitigate the ongoing crisis a jury has now ruled that they fueled.

The city will ask for up to $11 billion in abatement.