b'Pandemic Shows Value of Long-Acting Injectables for Severe Mental IllnessBy Annette M. BoyleVA research has found that about half of veterans with diagnosed schizophrenia or bipolar I disorder have attemptedcomes to the clinic versus what are the suicide. Nearly 70% of veterans with schizophrenia and morerisks of relapsing and getting into seri-ous problems if they dont come to the than 82% of those with bipolar disorder reported suicidalclinic and get an injection?ideation or behavior. Thats why it is so critically importantCalculating the risk of coming in for an injection goes beyond that faced by to maintain their medications during a crisis such as thethe healthcare professional involved. COVID-19 pandemic. Long-acting injectable drugs have Ifthereareadequatesuppliesof personalprotectiveequipment,then helped the VA do that. bringing in someone for an injection, the encounter, should not be high risk fortransmission,SaxontoldU.S. Medicine. But how is the patient get-SEATTLEAsthepandemicsweptAt the VA, teams took a case-by-caseting to the clinic? Are we putting oth-across the U.S. and shuttered hospitalsapproach.ers at risk on public transportation? In to all but COVID-19 patients, health- Itcomesdowntoaspecificdeci- addition, PPE might vary by site and care teams around the country debatedsion about each patient, said Andrewwhat theyre able to obtain.the best course of treatment for theirJ. Saxon, MD, director of the CenterThe risks of not receiving injections patientswithseverementalillness.of Excellence in Substance Addictionare clear for many patients.ShouldpatientswithschizophreniaTreatmentandEducation,VAPugetTheratesofmedicationnonadher-continueonlong-actinginjectables?SoundHealthCareSystem,andpro- enceareveryhigh,andtheconse-Should they be switched to oral thera- fessor in the department of psychiatryquencesareveryseriousforpatients pies to avoid the need to come into aand behavioral health at the Universitywithseverementalillness,Saxon clinic for injections? ofWashingtonSchoolofMedicine,noted. A patient who relapses could Ideally,patientsshouldbeseenasbothinSeattle.Whataretherisksend up in the hospital and they are at infrequently as medically prudent dur- of COVID transmission if the patienthigher risk for suicide.ingthispublichealthemergency,to limit the possibility of exposure (both patients and healthcare staff), accord- If there are adequate supplies of personal ing to SMI Adviser, an initiative of the American Psychiatric Association andprotective equipment, then bringing in someone the Substance Abuse and Mental Healthfor an injection, the encounter, should not be Services Administration. LAIs have pharmacokinetics that canhigh risk for transmission.be used to achieve this goal. Creative solutions may be needed to actually giveAndrew J. Saxon, MDthe injection, the advisory continued.Continued on Page 49 u2020 COMPENDIUM OF FEDERAL MEDICINE 39'