* Warning! Heavy jargon and potentially headache-inducing details ahead. Written for those who want to nerd out.*
⏰ Time to read: 10 mins
One of our values at Antelope Recovery is transparency, and this blog is our attempt at a very transparent peak under the hood of what has been happening in teen mental health over the last year. This industry report zooms into Colorado, industry trends, adolescent healthcare insights and ends with our focus for 2024.
As we know, over the past few years, the landscape of mental health challenges among young individuals has taken a distressing turn. Recent data from the CDC paints a stark picture: a staggering 109% surge in monthly overdose deaths among youths aged 10 to 19 between 2019 and 2021. Despite concerted efforts to curb these alarming statistics, teen mental health remains a formidable challenge for adolescents and families alike. Amidst this backdrop of escalating concerns, the investment of millions of dollars into teen mental health since 2019 hasn’t yet yielded the anticipated outcomes. Why? That’s a pivotal question we’ll address in this blog. We’ll delve into the events and progress of the past year within the realm of mental health—acknowledging areas of advancement and examining where strides forward have eluded us. Additionally, we’ll cast a hopeful eye toward the prospects of 2024 and the initiatives poised to make a difference.
Looking back on Colorado
The “4th wave’ of the overdose crisis has reached Colorado.
The big news in Colorado over 2023, is that what is now been dubbed ‘the 4th wave of the addiction crisis’ has made it to our state. In short: due to more stimulant use, addiction has become more complicated to treat and more deadly.
This 4th wave has been characterized by polysubstance use, where individuals use multiple types of drugs simultaneously rather than sticking to one drug of choice. In the last few years, fentanyl and opiates have taken the stage, and now, we are seeing a more complex story emerge. While fentanyl alone has tragically claimed thousands of lives in recent years, an alarming increase in overdoses results from combining fentanyl with other substances like meth, cocaine, ecstasy, and more. According to an article in the journal Addiction, the combination of fentanyl and stimulants, particularly meth, is a leading cause of overdose deaths nationwide. Provisional data from the CDC highlights that this concerning trend has reached Colorado and that from 2022 to 2023, there was a 2.26% increase in drug overdose deaths, primarily attributed to fentanyl combined with stimulants such as cocaine or meth.
Treatments for opiate addiction have evolved rapidly, offering promising Medication-Assisted Treatment (MAT) options, Narcan, fentanyl test strips, and other easy-to-deploy overdose prevention strategies. However, there are currently no options for stimulant addictions, and in fact, stimulant addictions can even compromise the effectiveness of MAT for opioid addictions. This New York Times article has tracked what this shift toward polysubstance use and overdoses means for treatment. Stimulant addictions are very complex and can be very challenging to treat. Finally, the American Medical Association’s latest Overdose Epidemic Report is on “the grim realities of worsening overdose epidemic,” which also identifies polysubstance use as a major issue. One silver lining in the AMA report is that Colorado seems to be making headway in some areas, such as more prescriptions for naloxone and medications for opioid use disorder (including buprenorphine), fewer prescriptions for opioids, and increased use of the PDMP.
Two new substances have emerged in Colorado:
These substances are not currently showing up in the teen population and are not something for parents to be concerned about. However, professionals who work in the addiction field should keep their eye on these showing up in adult populations:
- Xylazine is a non-opioid tranquilizer primarily used for animals, not approved for human use by the FDA. Despite being a non-opioid, it exhibits sedative effects akin to opioids. Its misuse by individuals has been linked to worsening the severity of cuts and wounds. Notably, there have been four associated deaths in 2022 and four more in 2023, all involving the concurrent use of fentanyl. The Colorado Department of Public Health and Environment (CDPHE) has initiated a coordinating work group to address the emerging concerns surrounding xylazine-related incidents. Additionally, recipients of the CDPHE Harm Reduction Grant Fund have the opportunity to purchase and distribute xylazine test strips, aiming to mitigate the potential harm caused by its misuse. Read this article from Pennsylvania’s Department of Health on how to treat Xylazine.
- Nitazenes represent a novel group of potent illicit synthetic opioids. Originally developed approximately 60 years ago as a pain reliever, these compounds were never officially approved for use in the United States. Notably, certain nitazenes exhibit an alarming potency that surpasses even fentanyl. The emergence of nitazenes in the illicit drug market has raised significant concerns due to their potency and association with adverse outcomes. In Colorado alone, there have been ten recorded deaths involving nitazenes from mid-2021 to the present, highlighting the severe risks posed by these substances.
3 Mental Health Industry Trends from 2023
As a healthcare start-up, we are tracking trends in healthcare closely! The following three trends we find most exciting:
- AI in healthcare
Generative AI has captivated the world since ChatGPT’s public launch in late 2022, the impact of which has reached digital mental healthcare. While AI has long propelled healthcare innovation – supporting patient triage, scheduling, and medical scribing – the mental health and substance abuse domain has yet to harness these advancements fully. We anticipate this integration will take several more years. AI-enabled solutions have amassed nearly $2.8B in funding across 101 deals (through Q3 2023), and we’re optimistic that AI-enabled solutions will eventually find a place in mental healthcare. However, significant hurdles lie ahead. For AI developers, concerns around algorithm bias based on non-diverse datasets and ensuring data privacy are key to making the leap to clinical application. There have been significant fears about the ethics of AI in mental healthcare from leaders in the counseling community, stressing that AI cannot replace therapy and discouraging short-term interventions such as CBT chat-bots claiming to be able to treat severe psychiatric disorders. Other members of the clinical community express optimism about these types of interventions and are embracing the potential for AI to increase accessibility to these services. We are particularly optimistic about the possibility of AI to reduce the clinical administrative burden of writing notes for insurance companies, tedious credentialing processes, insurance claim management, and more. The possibility that AI could “humanize” healthcare is very exciting and something we support.
- Value-based care enablement
Value-based care has been a topic of discussion for years in the industry, and presents hope for the broken health insurance system as an alternative payment system for providers. Like most new ideas, it has been challenging to adopt at scale. In 2023, we saw multiple VBC arrangements come forward, paving the way for VBC deals among large insurance companies. As related policy initiatives gain momentum, VBC enablement will become an important component of commercial roadmaps and will drive enterprise partnerships. The value-based care enablement landscape in 2024 will largely depend on the outcomes demonstrated by dominant national payers and managed service organizations and may be pushed toward platformization to support the complexity of these new systems.
- Data interoperability
One of the most relatable complaints between both providers and patients is the amount and frequency of forms, notes, and general paperwork required in healthcare. Data interoperability between EHRS (electronic health record systems) presents a hopeful solution to that. Making sure health data can be easily shared and used safely has long been a big deal in healthcare and continues to be a major challenge in digital mental healthcare. Laws like HIPAA and the HITECH Act, which are governed at the national level, set the rules for this. Many digital health companies are creating tools to help everyone comply with these rules and make the most of shared data to better coordinate care and minimize the administrative paperwork burden most healthcare providers have come to despise. Archaic systems are still the norm across the mental healthcare landscape – faxing is still the only way for many companies to communicate with insurers and external providers. The systems that let health data move between different places are still under construction. The ONC (Office of the National Coordinator for Health Information Technology) just began the first cohort of Qualified Health Information Networks, which is designed to improve data sharing. This has been in progress since the TEFCA plan was published in early 2022. As regulations for sharing data get clearer and stabilize (through our legal system processing major data leaks and mistakes), we expect 2024 to bring breakthroughs in data interoperability and hopefully relief for therapists and clients alike.
3 things we’re doubling down on this year:
When we started Antelope last year, we had an idea that these three components of our industry (Medicaid, Data, and Schools) would be important for us. However, this year, it’s now very clear that these relationships and strategies are worthwhile, and we wish every mental health company would focus on them.
- Working with Medicaid is essential for the true transformation of teen healthcare.
Medicaid is known for surprise audits, rejecting claims, lower quality care due to excessive bureaucracy, and less freedom for clinicians. However, we’ve learned that Medicaid insures nearly 50% of American adolescents. This means that state Medicaid programs have outsized impacts on adolescent health in the U.S. Any startup looking to impact adolescent healthcare must consider working with Medicaid programs and plans, including managed care organizations (These organizations distribute Medicaid funds and insure the uninsured). Learning how to get creative with Medicaid billing codes, create a strong impact despite the limitations of Medicaid, and rigorous clinical outcome data collection so we can better negotiate rates with Medicaid has been essential to our mission.
- Adolescent data management is different from adult and child data management.
Digital platforms have not evolved the data management requirements we need to work with adolescents and their parents appropriately. Most adolescent patient portals have proxy accounts, which adult caregivers use to understand their child’s health and communicate with providers. However, as children age, proxy account management grows more complicated. Privacy laws vary across states and institutions (for instance, 15-year-olds in Colorado can keep mental health information separate from parents). Proxy permissions are emotionally charged, balancing a patient’s right to privacy and a parent’s right to access their child’s medical records. The challenges of managing how adolescent patient data is shared with other parties or proxies have severely curbed digital health and data management initiatives, as many startups and enterprises are nervous about legal or PR repercussions. Adolescent healthcare leaders are calling for more attention here regarding technological innovation for pediatric patient portals and data interoperability!
- Providers need to be more connected to schools and schools with providers.
While less than half of US children have an established relationship with a healthcare provider, over 95% of children aged 5-17 attend school. Children spend nearly half of their waking hours in the classroom, making school a unique stakeholder and site of care for children. The connection between school and mental health is bidirectional: where schools can address access gaps, healthy students, in turn, have better grades and attendance, which has led to government programs linking school funding to student health. Accordingly, 17% of public schools offered telehealth services in the 2021-22 school year. As federal funding for school-based telehealth programs expires in 2024, school-based startups will need to double down on proving ROI to demonstrate long-term viability. At Antelope, we’ve dedicated significant resources to supporting school counselors and districts in providing telehealth to students in need, including through detention alternative plans, at-school casework, and supporting school counselors by offering assessments. With school counselors being underpaid and having very limited hours to address large populations, treatment programs can go the extra mile to bring external resources into these spaces.
What we’re excited about in 2024
At Antelope, we’re thrilled about pioneering new approaches centered on measurement-based care—a vital principle guiding our quest for improved client treatment and outcomes. After all, what isn’t measured can’t be effectively changed. This approach enhances our negotiation capabilities with insurers, prepares us for the imminent paradigm shifts in healthcare, and empowers our clients. We’re focusing on evidence-based clinical innovations, and fully take advantage of being virtual.
Here’s what’s on our horizon in 2024:
- Contingency Management Programming: Leveraging biomarkers to bolster remote teen recovery and engagement. (in other words, we’re gamifying drug testing for teens).
- Embedded Care: Our virtual programs are fully woven into a teenager’s life—be it at school, home, or within the family—paving the way for the child’s entire world to recover and heal alongside the individual.
Stay tuned for more updates! We’re excited to share further developments over the coming months as we step into the second year of our program. We are optimistic about 2024 and believe that the innovation in this field will begin to snowball in time.
Where you can access data about the addiction crisis and Colorado:
- CDPHE Drug Overdose dashboard
- Historic Drug Overdose Trends (2000-2022)
- NEMSIS Non-Fatal Opioid Overdose Tracker
- Consortium Opioid Dashboard
- Health Watch publications
- CDPHE Open Data Portal
- SEOW data publications
- SEOW fentanyl brief
- CDPHE Mortality Statistics Dashboard
- Colorado SUDORS Website
- Colorado consortium report