Researchers find that, overall, prescribing ADHD medications via telehealth does not alter risk of substance use disorder

Telehealth patients were not more likely to develop substance use disorder

Brigham and Women's Hospital

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• Telehealth patients were not more likely to develop substance use disorder

• Researchers found that a small number of people who received initial stimulant prescription via telehealth developed stimulant disorder and emphasize the importance of follow-up care

Telehealth can make health care easier to access for patients with attention-deficit/hyperactivity disorder (ADHD) who need treatment, but experts worry about an increased risk of substance use disorder for patients being prescribed controlled medications such as stimulants for ADHD during these appointments. Mass General Brigham researchers scrutinized this concern with the first-ever study comparing substance use disorder rates in patients with ADHD who were prescribed stimulant medications during in-person versus virtual appointments. They found that, overall, telehealth was not associated with increased risk of substance use disorder. Still, the researchers noted the importance of comprehensive diagnoses and routine follow-ups. Results are published in the American Journal of Psychiatry.

“Our study suggests that, generally, telehealth-based relationships – which make health care more accessible – can be safe and don’t increase the risk of substance use disorder,” said lead author Vinod Rao, MD, PhD, lead author of the paper and addiction psychiatrist and medical director of Adult Ambulatory Psychiatry at Massachusetts General Hospital (MGH), a founding member of the Mass General Brigham healthcare system.

The researchers examined the electronic health records of 7,944 ADHD patients between March 2020 and August 2023, a time when many physicians pivoted to online care in response to the COVID-19 pandemic. The researchers found that 91% of the patients had at least one in-person visit with the prescriber around the time they received a stimulant prescription, while 9% of the patients had a telehealth-only relationship with their doctor.

The study found that, overall, patients who only had telehealth visits to access their ADHD medication were not more likely to develop a substance use disorder compared to patients who initially met their prescribers in person, after adjusting for other factors like age and income. However, patients who received their initial stimulant prescription through telehealth were at a higher risk of developing a stimulant use disorder after adjusting for other factors. Stimulant use disorder involves drugs such as prescription medications, cocaine or methamphetamine, among other drugs. Patients aged 26 years and above who received an initial stimulant prescription during a telehealth appointment were at a higher risk of developing substance use disorders than younger patients.

The authors note that, given that only 19 patients in the study developed a stimulant use disorder, the finding could be coincidental. Another possibility is that those who opt for telehealth care are at higher risk for stimulant use disorder.

“While we think the findings should be replicated, the vast majority of the data show no increase in substance use disorder developing when patients exclusively use telehealth,” said corresponding author Timothy Wilens, MD, chief of the Division of Child and Adolescent Psychiatry and co-director of the Center for Addiction Medicine at MGH. “Our study supports the use of telehealth for ADHD stimulant therapy in clinical settings.”

Authorship: Mass General Brigham authors include Vinod Rao, Sylvia Lanni, and Timothy Wilens. Additional authors include Amy Yule, Sean McCabe, Philip Veliz, and Ty Schepis.

Disclosures: Wilens has co-edited several books on ADHD, holds licensing agreements with Ironshore and 3D Therapeutics, serves as a clinical consultant to multiple organizations including U.S. Minor/Major League Baseball, and has received funding from NIDA. Yule has received research funding from the NIH, the Doris Duke Charitable Foundation, and the National Center for Advancing Translational Sciences, as well as support for clinical program development and consulting roles with various organizations.

Funding: The development of this study was supported by a research award 75F40121C00148 from the US Food and Drug Administration and research award UH3DA050252 from the National Institute on Drug Abuse

Paper cited: Rao V et al “Telehealth prescribing of stimulants for ADHD and associated risk for later stimulant and substance use disorders” AJP DOI: 10.1176/appi.ajp.20240346

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About Mass General Brigham

Mass General Brigham is an integrated academic health care system, uniting great minds to solve the hardest problems in medicine for our communities and the world. Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services. Mass General Brigham is a nonprofit organization committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations with several Harvard Medical School teaching hospitals. For more information, please visit massgeneralbrigham.org.

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Journal

American Journal of Psychiatry

DOI

10.1176/appi.ajp.20240346 

Method of Research

Observational study

Subject of Research

People

Article Title

Telehealth prescribing of stimulants for ADHD and associated risk for later stimulant and substance use disorders

Article Publication Date

11-Jun-2025

COI Statement

Wilens has co-edited several books on ADHD, holds licensing agreements with Ironshore and 3D Therapeutics, serves as a clinical consultant to multiple organizations including U.S. Minor/Major League Baseball, and has received funding from NIDA. Yule has received research funding from the NIH, the Doris Duke Charitable Foundation, and the National Center for Advancing Translational Sciences, as well as support for clinical program development and consulting roles with various organizations.

 

New hydrogel treatments turn water waste to fertilizer

Washington University in St. Louis

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By Beth Miller

Excessive nutrients in wastewater can lead to detrimental discharges into natural water bodies, prompting harmful algal blooms with severe environmental and economic repercussions. To address this pressing issue, a team of engineers in the McKelvey School of Engineering at Washington University in St. Louis has developed an innovative solution. Their novel composite nanotechnology removes and recovers nutrients from wastewater, subsequently upcycling them as agricultural fertilizers or as biorefinery feedstocks, while simultaneously mitigating the occurrence of harmful algal blooms. 

Young-Shin Jun, professor of energy, environmental and chemical engineering, and Minkyoung Jung, a doctoral student in her lab, created novel mineral-hydrogel composites that can remove and recover ammonium and phosphate from wastewater. These composites are embedded with nanoscale struvite and calcium phosphate mineral seeds, which significantly reduce ammonia and phosphate concentrations in wastewater by up to 60% and 91%, respectively. This reduction curbs algal growth and the associated toxins. This technology’s potential impact is underscored by a 2000 report from the U.S. National Oceanic and Atmospheric Administration, which estimated annual economic losses from harmful algal blooms in U.S. coastal waters to be between $33.9 million and $81.6 million.

Results of the research were published online May 29, in a special issue of Environmental Science & Technology “Advancing a Circular Economy.”

Like the moisture-absorbing gel in the core of disposable diapers, the hydrogel can soak up and repurpose excess nutrients. For their sustainable solution, Jun’s team used a nature both as a model and for a beneficiary of its method.

“We designed these hydrogel composites to recover ammonia and phosphate, essential nutrients whose overabundance causes algal bloom,” Jun said. “Ammonia synthesis is energy-intensive, and phosphorus resources are dwindling. Our mineral-hydrogel composites allow us to harvest these nutrients from wastewater and repurpose them as fertilizers and feedstock for biorefineries.”

The process uses nanoparticle nucleation – the initial step in forming a solid phase in an aqueous system, similar to sugar crystals forming on a string to make rock candy. To facilitate that process, Jun’s team planted ultra-small mineral seeds in the hydrogel that were created from calcium phosphate and struvite, a mineral composed of magnesium, ammonium and phosphate that binds with calcium and other cations and ions. The ammonia and phosphate bind to the seeds and bulk up the hydrogel. During the process, the average particle sizes of the hydrogel increased from 6.12 nanometers to 14.8 nanometers.

Their approach addresses three significant challenges of conventional nutrient removal: inefficient collection in traditional methods, balancing the removal of both ammonia and phosphate and maintaining consistent removal efficiency in complex water conditions. This method achieves exceptionally low nutrient levels, effectively preventing harmful algal blooms.

Jun highlighted the scalability of the process, with successful trials conducted on up to 20 liters of fluid. The lab is now scaling up to 200 liters.

“This demonstrates the practical application potential of our fundamental scientific research, showing a viable path from the laboratory to everyday technology,” Jun said. “This pioneering work represents a significant advancement in environmental engineering, turning a waste problem into a valuable resource and exemplifying sustainability in action.”

Jun worked with WashU’s Office of Technology Management to patent the mineral hydrogel technology.

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Jung M, Wang Y, Ilavsky J, Tang Y, Jun Y-S. Molecular insights into novel struvite-hydrogel composites for simultaneous ammonia and phosphate removal. Environmental Science & Technology, online May 29. https://pubs.acs.org/doi/10.1021/acs.est.4c11700

 

Funding for this research was provided by the U.S. Environmental Protection Agency and the U.S. Department of Energy.

 PHILIPPINES

Survey reveals bleak job prospects for Pinoy nursing, MD graduates

Ateneo de Manila University

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Earning a degree in medicine or nursing may not necessarily open as many doors as young graduates hope, new research from Ateneo de Manila University shows. The researchers found that many new graduates feel lost and unsupported when they join the workforce. Also, according to many interviewees, the country’s medical and nursing education system is too focused on hospital-based care, leaving them ill prepared to handle community work, government systems, and health programs. Further, many health facilities point to restrictive hiring rules and budget ceilings as barriers filling vacant posts.

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Credit: Aaron R Vicencio / ADMU

Ateneo de Manila University researchers warn that young Filipinos graduating with a degree in nursing or medicine face an uphill battle for stable employment, fair pay, and meaningful roles in the local public health system.

This comes as the Philippines faces a massive shortage of health professionals, with less than eight doctors per 10,000 people—below the international standard of 10 per 10,000—and over 127,000 vacancies for nurses, particularly in rural areas and private facilities.

The researchers found that many new graduates feel lost and unsupported when they join the workforce.

“I finished my MD from one of the best schools in the country,” said a municipal health officer assigned to a remote area. “But when I worked here, it was an entirely different ballgame. We weren’t trained how to deal with the local administration and procurement, how to talk to local chief executives. I wasn’t prepared nor trained for this—but this is how we make things happen.”

According to many of the researchers’ interviewees, the country’s medical and nursing education system is too focused on hospital-based care, leaving them ill prepared to handle community work, government systems, and health programs.

Further, many health facilities point to restrictive hiring rules and budget ceilings as barriers filling vacant posts. For example, local government units (LGUs) are required to allocate no more than 45% of their annual budget to salaries. This forces overworked nurses to take on multiple roles, often without additional pay.

“The 45% cap on personnel services really prevents us from hiring,” said a provincial health official. “You see a ward nurse being assigned as the public health nurse… and also as a records officer. That’s extra work, no extra compensation.”

As a result, fresh graduates are forced into a frustrating dilemma: many are willing to serve in the public sector, but are either not qualified under strict civil service requirements, or are offered short-term contracts with no job security or clear path for career growth. Meanwhile, private facilities struggle to match government pay scales, and both sectors lose workers to better-paying jobs abroad.

“The nurses we lost are our best nurses,” said one hospital administrator. “It is painful that the trained ones are the ones who leave. The ones left with us are either the new ones or the very old.”

Training, too, is a problem: medical facilities across the country and their staff need to meet new standards aligned with the Universal Health Care (UHC) Law, but some clinics say they are forced to pay out of pocket for training fees and accreditation requirements—sometimes spending over ₱50,000, while getting back only ₱2,000 from government reimbursements.

So is it still worth pursuing a career in healthcare?

The researchers believe the answer is yes—but only if key reforms are made, including scholarships with return service agreements; better integration of community health in school curricula; less restrictive hiring policies; and stronger support for newly-deployed health workers.

These problems and proposed solutions were laid out in the recent peer-reviewed paper, “Health Workforce Issues and Recommended Practices in the Implementation of Universal Health Coverage in the Philippines,” conducted by Veincent Christian F. Pepito, Arianna Maever Loreche, Ruth Shane Legaspi, Ryan Camado Guinaran, Theo Prudencio Juhani Z. Capeding, Madeline Mae A. Ong, and Manuel M. Dayrit of the Ateneo School of Medicine and Public Health and the University of the Philippines-Manila.

 

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Journal

Human Resources for Health

DOI

10.1186/s12960-025-00988-3 

Method of Research

Survey

Subject of Research

People

Article Title

Health workforce issues and recommended practices in the implementation of Universal Health Coverage in the Philippines: a qualitative study

 

Book explores how ‘domestication’ of environmentalism limits who it protects

University of Illinois Urbana-Champaign landscape architecture professor Pollyanna Rhee examines how the modern environmental movement has been used to protect the property and interests of affluent homeowners in her new book, “Natural Attachments."

University of Illinois at Urbana-Champaign, News Bureau

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University of Illinois Urbana-Champaign landscape architecture professor Pollyanna Rhee examines how the modern environmental movement has been used to protect the property and interests of affluent homeowners in her new book, “Natural Attachments: The Domestication of American Environmentalism, 1920–1970.”

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Credit: Courtesy Pollyanna Rhee

CHAMPAIGN, Ill. — The response to a 1969 oil spill off the coast of Santa Barbara, California, reveals how the modern environmental movement has been used to protect the interests of private homeowners, said a University of Illinois Urbana-Champaign researcher.
Landscape architecture professor Pollyanna Rhee chronicled how affluent homeowners use what she calls “ownership environmentalism” to focus on protection of property and community norms, rather than society as a whole, in her new book “Natural Attachments: The Domestication of American Environmentalism, 1920–1970.”
Rhee said she was interested in examining how people create an environmental consciousness and develop ideas about what a healthy, high-quality environment looks like. Santa Barbara was a good case study because of its long history of community involvement and because the oil spill shone a spotlight on its environmental concerns, said Rhee, who spent a year-and-a-half living and doing research in the city.
The Santa Barbara oil spill drew national attention for its damage to the picturesque coastline and inspired the founding of Earth Day and the Environmental Protection Agency. In the same year as the oil spill, the heavily polluted Cuyahoga River in Ohio caught fire, but the fire did not garner the same level of news coverage and outrage as did the oil spill, Rhee said.
At the time of these disasters, the country was moving from a focus on conservation, which was concerned with natural resource management and was led by scientists, experts and government officials, to environmentalism as a social movement of ordinary citizens, she said.
Their concerns included exposure to chemicals and industrial pollution, the nuclear threat, the destruction of wilderness for highways and suburbs, and the desire for places for outdoor recreation.
“They were concerned about quality of life, and environmentalism was a big part of that,” Rhee said.
At the same time, the government was encouraging home ownership and private developers were creating neighborhoods with racially restrictive covenants. Ownership environmentalism centered on maintaining social hierarchies and protecting particular places, and it opted for protection rather than justice, she wrote.
Such environmentalism was often seen on the small scale of everyday lives — in how people plant their lawns, for example — rather than on a national policy level. “There is not an overarching political vision or a well-informed idea of what environmental quality should be,” Rhee said.
The social movement echoed earlier rhetoric of the 1920s and ‘30s, which concerned itself with local issues, such as the natural beauty of a place, and was led by home gardeners and voluntary civic organizations run mostly by women, she said.
After a 1925 earthquake destroyed Santa Barbara’s downtown, the city rebuilt in a unified Spanish Colonial Revival architectural style now codified in city regulations.
“It was embraced as a style that was supposed to be aligned with the climate and geography of the place, the mountains and beaches, and the Spanish and Mexican history that wealthy whites wanted to embrace,” Rhee said.
The oil spill challenged their expectations of the environment, but the concerns weren’t about changing the status quo or seeking a reduction in fossil fuel use, Rhee said. Instead, the citizens of Santa Barbara sought to protect their community and believed oil extraction should be located elsewhere, such as in Alaska or the Middle East.
“The political horizons for this type of environmentalism are restricted to a privileged few. It conveys a lot of what people think of as the scope of their environmental responsibilities. I think it’s a major reason why environmentalism has faced a lot of criticism for its lack of concern about equity and justice,” she said.
The criticisms of the environmental movement include that it has no relevance to the lives of many people and appeals to a narrow range of interests of the well-off for open spaces, wilderness and biodiversity. It also is seen as antigrowth. Communities have used ownership environmentalism to oppose multifamily housing developments and urban sprawl.
“Environmentalism is a pretty effective weapon, not just in Santa Barbara but in a lot of affluent places more generally, to use the protection of green space or nature preserves as a way of limiting a certain type of development,” Rhee said. “The limited social relevance of environmentalism is because of how these interests are wielded — not in the way of expanding equity or justice but in protecting people who already have these privileges.”
Ownership environmentalism is not limited to Santa Barbara. Such attitudes are shared in other affluent communities. But they are facing more outward criticism from environmental justice and climate activism movements and from advocates for affordable housing, Rhee said.
She said she believes there is value in thinking about environmental issues such as biodiversity, as well as examining the way we live and how that aligns with larger political and structural forces.
“It’s worth thinking about how people’s everyday lives and experiences are major factors shaping how they think about environmental health and environmental quality,” Rhee said. “I wanted to see how people respond to environmental pressures that are close to home.”

Editor’s note: To contact Pollyanna Rhee, email cyrhee@illinois.edu.

 

Growing influence of neuroscience training risks leaving the teaching profession devalued, study warns

University of Exeter

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The growing trend of encouraging educators to learn about how children’s brains work can offer reassurance, but it risks teachers’ autonomy and critical thinking, a new study warns.

Neuroscience is having a growing impact on the way teachers work. This is shown by the increasing number of professional development courses about the subject for those working in schools around the world.

The study warns this training does not always take account of the social context in which schools operate. If teachers are told biological information is more important than their pedagogical training and experience they could feel devalued, despite the possible positive influence of the training on their work.

Researchers say neuroscience can be a useful tool, but only when viewed critically and not shown as the superior or only way to teach. The courses they examined in Chile are often not regulated or inspected, and left to the rules of the market, so should be used in conjunction with the skills and socio-educational knowledge teachers have, rather than in isolation.

The study, by Daniel Leyton and Lauren Stentiford, from the University of Exeter, is published in the journal Critical Studies in Education.

Dr Leyton said: “The professional value of teachers’ other skills is equally as important and should be respected. Neuroscience training which has information about learning styles, how the brain learns, and the sort of food children should eat to increase their capacity, for example, can be a useful addition and are well intentioned but care needs to be taken to ensure the teaching profession is not left devalued, and teachers keep bringing nuanced understanding of inequalities and injustices in schools.”

The study says neuroscience training can be empowering, but its increasing use in schools risks weakening teachers’ understanding of themselves and students and parents and the historical and social contexts in which schools operate.

Researchers interviewed 19 teachers and teacher educators in Chile. Those working in schools in that country work in an environment where they are often regularly observed or set targets, which puts pressure on them to experiment with tools such as neuroscience.

They also mapped CPD courses in neuroscience available for teachers in Chile run from 2007 to 2023 and examined neuroscience information on YouTube videos, podcasts, media interviews, academic journals and books.

Through the interviews, they identified a shift towards neuroscience as a new authoritative knowledge and a change in teachers’ pedagogical language.

Dr Stentiford said: “Interviewees spoke about their motivations for pursuing CPD or postgraduate neuroeducation courses, links unfolded between acquiring neuroscientific knowledge and regaining authority through certainty. They felt undertaking training in neuroscience education had represented a path to professional legitimacy.  Some were energised by neuroscience’s promise. Others criticised the marketisation of neuroscience as the source of pseudo-experts.”

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Journal

Critical Studies in Education

DOI

10.1080/17508487.2025.2493835 

Article Title

Neuroscience, biopolitics and new professional subjectivities in education

‘Fingerprinting’ plant compounds helps explain food, drink tastes

Researchers develop method to determine what compounds affect bitter taste, mouthfeel in wine, dark chocolate, other foods and drinks

Penn State

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Study first author Yanxin Lin, left, and senior author Misha Kwasniewski examine the structure of the chemical catechin, an important polyphenol and building block of tannins. The new tannin-measurement method breaks large, complex structures into catechin ions and other fragments to characterize the original structure. 

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Credit: Penn State

UNIVERSITY PARK, Pa. — In red wines, ciders and dark chocolate, just to name a few, complex plant compounds called procyanidins contribute to the taste and mouthfeel of a food or beverage — its perceived astringency and bitterness. But while food scientists have been able to assess the total content of procyanidins in a food or drink, they have not yet identified which specific procyanidins are present and correlate to specific perceptions. But now, for the first time, a team led by researchers at Penn State has developed a method of “fingerprinting” procyanidins, introducing a more sophisticated and accurate way to analyze the perceptual variation in many foods and drinks.

“Drinking red wines, sometimes that tannic element is really harsh, like dragging sandpaper across your tongue, and sometimes it is velvety or smooth — and yet those two wines can have the same absolute amount of procyanidins, also referred to as condensed tannins,” said team leader and senior author Misha Kwasniewski, associate research professor of fermented beverage science and technology in the College of Agricultural Sciences. “We wanted to understand the biological activity of taste and mouthfeel, but this goes beyond taste and mouthfeel because procyanidins also are responsible for antioxidant activity and health-related benefits, and current analytical methods often show a lack of correlation with biological activities and health-related benefits.”

According to Kwasniewski, current analytical methods only measure the total amount of procyanidins, rather than differentiate between them, so it can be difficult to determine how astringent a wine feels or how healthy a food might be. In a study published in Journal of Agricultural and Food Chemistry, the researchers described an advanced analytical chemistry method they named Condensed Tannin Fragmentation Fingerprinting. It is based on a technique known as in-source fragmentation, in which molecules from a food or beverage sample are identified using a laboratory device called a mass spectrometer.

Greatly simplified, the process first separates compounds in the sample. Then, different voltages are applied to break the procyanidins into fragments that the researchers can match to known standards, allowing them to identify and quantify each type of procyanidin.

In the study, the researchers tested the effectiveness and accuracy of their Condensed Tannin Fragmentation Fingerprinting method on 19 complex samples containing known amounts of various condensed tannins. The method demonstrated high accuracy and precision in characterizing condensed tannins present, Kwasniewski said. Then the researchers used it to analyze eight commercially available ciders with similar results, validating the concept.

Now, Kwasniewski’s research group is working with Pennsylvania winemakers to improve the quality of their products. In cool climates like Pennsylvania, he explained, wines tend not to have “as big a mouthfeel” as wines made from grapes grown in warmer climates — they have a less intense “dry” astringency profile.

“We want to learn how winemakers here — whether it be through new breeding programs and new grape varieties, or wine-making techniques or any number of interventions — can make the type of wines that they want to make, and sometimes that will be wines that have greater amounts of astringency,” Kwasniewski said. “The current methods that were available for understanding what was going on with the tannin structure really don't work with Pennsylvania wines.”

Yanxin Lin, doctoral degree student in food science, was first author on the study. Helene Hopfer, Penn State associate professor of food science, and Qining Zhang, doctoral candidate in the Department of Electrical Engineering and Computer Science, University of Michigan, contributed to the research.

The U.S. Department of Agriculture’s National Institute of Food and Agriculture and the Crouch Endowment for Viticulture, Enology, and Pomology Research in the College of Agricultural Sciences at Penn State supported this research.

A collection of wines being analyzed for their tannin fingerprints sits in front of one of the liquid chromatography–mass spectrometry machines used to develop the new method. These wines are part of the next research phase, which seeks to better understand the link between tannin structure and mouthfeel.

Yanxin Lin, a postdoctoral candidate in the Department of Food Science and lead author of the study, reviews data generated by the new tannin-characterization method.

Credit

Penn State

Journal

Journal of Agricultural and Food Chemistry

DOI

10.1021/acs.jafc.5c02379 

Method of Research

Experimental study

Article Title

Fingerprinting and Quantification of Procyanidins via LC-MS/MS and ESI In-Source Fragmentation