BEHAVIORAL HEALTH CORNER

The Centers for Disease Control and Prevention (CDC) has released the Youth Risk Behavior Survey (YRBS) Data Summary & Trends Report: 2013–2023 providing a summary of data as well as trends from 2013 to 2023 for adolescents’ sexual behavior, substance use, exposure to violence, mental health, and suicidal thoughts and behaviors. The report reflects data collected every two years from a sample of U.S. high school students that is representative of adolescents nationwide. Data for substance use (e.g., ever used select illicit drugs, ever misused prescription opioids, current alcohol use, current marijuana use) and sexual risk behaviors (e.g., ever and current sexual activity, having four or more lifetime sexual partners) have shown continued improvement in 10-year trends. However, worsening trends were reported for protective sexual behaviors, experiences of violence, persistent sadness or hopelessness, and suicidal thoughts and behaviors. Disparities persist for female students as well as for students who identify as lesbian, gay, bisexual, transgender, questioning, or another non-heterosexual identity (LGBTQ+). For example, in 2023, more than half of female students reported persistent feelings of sadness or hopelessness in the prior year, and LGBTQ+ students were more likely than their peers to have used or misused substances and to have experienced all forms of violence, signs of poor mental health, and suicidal thoughts and behaviors. The CDC has developed an action guide to assist schools in supporting students’ mental health, and nationally, additional resources have been developed. Efforts continue to support adolescents and ensure these individuals have the knowledge and resources needed.

Shortages of stimulants for the treatment of attention-deficit/hyperactivity disorder (ADHD) continue to be reported. Availability of generic methylphenidate HCl extended-release (ER) tablets is variable depending on the manufacturer. Brand-name Relexxii® from Vertical, as well as brand-name Concerta® from Janssen, are currently available. Shortages of the generic version of Vyvanse®, lisdexamfetamine dimesylate capsules and chewable tablets persist. Brand-name Vyvanse® capsules and chewable tablets remain available from Takeda. Generic amphetamine aspartate monohydrate, amphetamine sulfate, dextroamphetamine saccharate, and dextroamphetamine sulfate immediate release (IR) tablet shortages also continue from a few manufacturers. Brand name Adderall® IR tablets from Teva are available.

WEIGHT MANAGEMENT CORNER

Data from IQVIA’s National Prescription Audit PayerTrak published in a JAMA Health Forum Research Letter have demonstrated the number of semaglutide (Ozempic®, Wegovy®, Rybelsus®) prescriptions filled increased by 442% between January 2021 and December 2023 (from 471,876 to 2,555,308) with Ozempic® being > 70% of fills. Prescription fills increased by 392% for Ozempic® between January 2021 and December 2023, and 1,361% for Wegovy® between July 2021 and December 2023. These data from IQVIA encompass 92% of prescriptions dispensed to individuals at retail pharmacies across the U.S. Analysis was also conducted to evaluate payment method (e.g., commercial insurance, Medicaid, Medicare Part D, cash). Although monthly semaglutide claims increased for all payment methods, prescriptions processed through commercial insurance consistently demonstrated the largest number of fills, especially for Wegovy®.

A nationwide population-based emulation target trial based on electronic health records between December 2017 and March 2023 suggests an association between semaglutide and a significantly lower risk for medical encounters for tobacco use disorder diagnosis in patients with type 2 diabetes mellitus (T2DM) compared with other antidiabetic medications. Findings were based on seven target trials that were emulated across eligible patients with T2DM and tobacco use disorder. New use of semaglutide was compared with insulins, metformin, dipeptidyl-peptidase-4 inhibitors, sodium-glucose cotransporter-2 inhibitors, sulfonylureas, thiazolidinediones, and other GLP-1 receptor agonists (RAs). Further studies are needed to assess semaglutide’s role in tobacco use disorder treatment.

In recent months, shortages of GLP-1 RAs that are indicated for select patients as an adjunct to a reduced calorie diet and increased physical activity for chronic weight management have been reported by the FDA. As of August 2024, some of these shortages appear to be resolving or improving. Eli Lilly’s tirzepatide (Zepbound®) is being reported as currently available in all strengths, as is the tirzepatide (Mounjaro®) formulation indicated as an adjunct to diet and exercise in adults with T2DM. Additionally, all strengths of Novo Nordisk’s semaglutide (Ozempic®) formulation for select patients with T2DM are available, along with all strengths, except for the 0.25 mg strength, of the semaglutide product indicated for weight management (Wegovy®). Novo Nordisk’s liraglutide (Saxenda®) has limited availability, as does the liraglutide (Victoza®) formulation indicated for select patients with T2DM. The GLP-1 RA dulaglutide (Trulicity®), indicated for select patients with T2DM, has availability in the 0.75 mg and 1.5 mg strengths; the 3 mg and 4.5 mg products have limited availability through the third quarter of 2024 due to increased demand for the drug.