Treating Serious Mental Illness (SMI) With Long-Acting Injectable Medications - Episode 5

Aggressive Community Treatment Teams Role

Troy Trygstad, PharmD, MBA, PhD: The latest evolution, it seems to me, is not necessarily with new mechanisms of action, but new ways of administration. What is the 30-second overview of long-acting injectables? How did they come to pass, and what do those look like in practice?

Carla Cobb, PharmD, BCPP: So, I think where they came from is the difficulty with adherence. We all are well aware that adherence with medications to treat any condition is difficult, but it’s especially difficult in mental illnesses. Patients aren’t often aware. They may be in denial of their symptoms. They may actually feel the side effects of a medication before they see any therapeutic benefit or improvement in their symptoms. And so, adherence is a big challenge. That’s really where the idea of the long-acting injectables came from. Back with the first-generation antipsychotics, we have a couple of examples that were used, but they were difficult to dose, and there were many side effects associated with them. And so, now with the second generation of psychotics, still lumped into 1 category, but…

Troy Trygstad, PharmD, MBA, PhD: Unfortunately, in your opinion, right?

Carla Cobb, PharmD, BCPP: Unfortunately, yes. So, now we have several different molecules that are available in a long-acting injectable form. And the other nice thing is that they are available in different lengths of treatment. So, it’s getting longer and longer. Now we’ve got products that can be administered every 3 months. And so, that’s really helpful in especially helping with adherence.

Troy Trygstad, PharmD, MBA, PhD: So, in our armament, we have adherence packaging, so on and so forth. There’s the long-acting injectables. Before we had those, and still today, we have these ACT teams, right? Can you describe what an ACT team is? I’ve had the fortune of having some interaction with them, and they’re quite remarkable. But they’re also very intensive. So, what does an ACT team do, just for the general viewing audience? And what does ACT stand for maybe?

Carla Cobb, PharmD, BCPP: Well, we usually call it PACT, or Program for Assertive Community Treatment.

Troy Trygstad, PharmD, MBA, PhD: Assertive Community Treatment sounds like something the military would have put together. But it basically means we’re going to come find you, and administer your medication essentially.

Carla Cobb, PharmD, BCPP: Some people talk about it being the hospital without walls. So, people may be released from hospitalization, and an ACT program provides all of those services while the person is based at home. Usually, there are psychiatrists, nurses, social workers, and case managers as part of that team, and generally somebody has a touch point with that patient on a daily basis to check in and make sure they’re doing well. Often, medications are administered as part of that team on a daily basis as well.

Troy Trygstad, PharmD, MBA, PhD: So, it sounds very helpful, but also probably resource intensive. Has it been your experience at all that long-acting injectables give us the opportunity maybe to scale the idea of medication with being with the patient? Still needing access to other types of care team members, but does it allow us to open up the breadth of the population who still have severe mental illnesses, but there’s probably only so many slots for ACT teams. Have these long-acting injectable therapies allowed folks to interact with a patient much in the way Coumadin did in some ways? Where we’re meeting regularly because we’re injecting the patient, but that I don’t necessarily have to go find the patient every day if I’m administering? The patient has tuberculosis, and I’m viewing oral administration. So, what kind of practice changes have happened at all? Or what types of populations are being touched, if at all, and in a different way now that the long-acting injectables are there?

Carla Cobb, PharmD, BCPP: I think it’s probably less of an impact, and maybe the other panelists can comment more, but to me, it would be less of an impact for the PACT or ACT team members because somebody is seeing them daily and administering their medication. I think the long-acting injectables are more helpful for people who don’t have that level of care and service. Maybe people who live in rural areas and have to travel a distance, and don’t have access to that kind of intensive level of treatment, and so this gives them the opportunity to make sure that they’ve got their medication on a daily basis without having to necessarily see someone on a daily basis.