# 20231231 ☕️ Sunday Morning Coffee Notes Three `random notes` from my Obsidian vault, today's `music` selection from ~~MailTape~~WTMD, and a `photo` from the past week from my phone. Happy New Year to all! --- ## 📸 "Koresh Morgh-e Bademjan" ![[Pasted image 20240101122546.png]] #photo #food Veggies for this eggplant and chicken #stew recipe from Naz Deravian's Persian cookbook, _Bottom of the Pot_. I made it on Christmas day to bring to a family gathering. 4th time I've made it, and it is so-o-o good. Mind you, I do not like eggplant, so if that is you, it's worth a try. --- ## ![[Open random note.png]] Three notes from the Random Note core plugin. This is how I am dipping my toe into [Obsidian Publish](https://publish.obsidian.md) by adding at least 3 notes per week from my library of 6800+ notes. --- ## 🎲 SAMHSA Strategic Initiatives (2015-2018) Outline of 6 areas of strategic initiatives for #SAMHSA, developed 9 yrs ago (so it is out of date). After applying for the Senior Medical Advisor position in October 2016 at the request of [[Anita Everett]], I began reading documents like this, figuring out where my interests and background intersected with the work of the federal agency. Sections 2 (systems integration) and 5 (health IT) were of most interest to me. As I look at this now, I note some of the areas still needing attention. In Area #2, [[SAMHSA 2015-2018 Strategic Initiatives#2. Systems Integration|Systems Integration]], these remain relevant: - reducing disparities in access to MH/SUD care - integration between MH/SUD and rest of healthcare, especially primary care (Goals 2.1) - support for financing models, eg, collaborative care #CoCM (Goals 2.3) - implement MHPAEA ( #parity law) (2.4) - advance quality indicators In Area #5, [[SAMHSA 2015-2018 Strategic Initiatives#5. Health IT|Health IT]] is particularly behind the curve, as many specialty #EHR's (electronic health records) that focus on mental health (MH) and substance use disorders (SUD) do not integrate well with other EHRs. Recall that MH/SUD providers were largely excluded from the ~$30B spent on the #HITECH Act's incentives for physicians, hospitals, and the healthcare system to become computerized by supporting health IT standards and certifications in the late 2000s and early 20-teens. This led to a bifurcation in technology, with most MH/SUD EHRs not becoming certified by ONC. > I particularly call out the [[SAMHSA 2015-2018 Strategic Initiatives#SI 5 Goals, Objectives and Metrics|5.1 Goal]] of promoting tech standards to enable interoperable exchange of MH/SUD data, and the 5.3 Goal related to secure data collection to support quality improvement and outcome tracking. Given the ongoing increase in opioid related deaths, an obvious next step could be integration of national standards for substance use disorders within the IT infrastructure, such as [LOINC](https://loinc.org/LP263512-8), [SNOMED](https://www.snomed.org/use-snomed-ct), [USCDI](https://www.healthit.gov/isa/united-states-core-data-interoperability-uscdi#uscdi-v4), and FHIR. Some of these are already built out, but I am particularly thinking of the standards from The #ASAM Criteria, including [the assessment](https://www.asam.org/asam-criteria/implementation-tools/criteria-intake-assessment-form), the ranking of risk, and the names and standards for the 18 different levels of care (including the COE variants) across four levels of intensity. These need to be codified to standards to enable interoperable exchange of clinical data, which would also improve the efficiency of healthcare operations (eg, see the HL7 [DaVinci Project](https://build.fhir.org/ig/HL7/davinci-pas/)). > [!note]- ASAM Levels of Care >  --- ## 🎲 [[20180824 q-PL18 pg090|PL18-090: DEA-Changing Hydrocodone to Schedule II]] (2018) This is a page from #notebook #PL18. It has notes about the public comments in 2014 against (NO) and for (YES) changing hydrocodone to Schedule 2, making it more difficult to prescribe. This was one of the earlier attempts to get some control over the #opioid epidemic, which really started to ramp up around 2014. 52% of public comments supported this change. People suffering chronic pain were mostly against it. --- ## 🎲 #ICRS Talk on Anxiety and Cannabis (2019) #MMJ This is a page from #notebook #GR19, when I attended the 2019 International Cannabinoid Research Society or [ICRS](https://www.icrs.co) meeting in DC. [[Staci Gruber]] gave a talk entitled, "_High Anxiety? Examining the Impact of Four Weeks of Treatment With a Novel High Cannabidiol Product_." The reseearch came out of McLean Hospital, an open label study using a high #CBD whole plant product for people with a high Beck #Anxiety Index (BAI). They found an 80% reduction in BAI and in Beck Depression scores over 5 weeks. You will note my comment that the numbers look too good, and a plan to perform a double-blind placebo-controlled (DBPC) trial was discussed. I think this study in [Community Medicine](https://pubmed.ncbi.nlm.nih.gov/36352103/) is the open label trial results. I've not seen the #DBPC study she mentioned. See also [this 2022 review article](https://pubmed.ncbi.nlm.nih.gov/34952255/) that concludes with: > "_There is currently not enough high-quality evidence to suggest the clinical use of CBD for any psychiatric disorder._" --- ## ![[Pasted image 20231231192315.png|48]] Top 89 Songs for 2023 #mailtape No recent Mailtapes have been posted. So instead, I am linking to the [WTMD 89.7FM list of top 89 songs for 2023](https://www.wtmd.org/radio/2023/12/27/results-are-in-view-the-top-89-songs-of-2023/) -- voted for by radio listeners. I encourage you to support this excellent college radio station (Towson University). --- [[20231224 ☕️ Sunday Morning Coffee Notes|Prior]] <> [[20240107 ☕️ Sunday Morning Coffee Notes|Next]] [[20230625 Thinking about ☕️ Sunday Morning Coffee Notes|About coffee notes]] [[Home#Contact|Contact me]]