Clinicians, researchers, and vendors in the neurotechnology field have a lot more to think about given recent news about involuntary outpatient commitment programs. One such program in New York State, known as Kendra’s Law in honor of a victim of a subway attack by an individual with untreated schizophrenia, provides intensive caseworker monitoring to ensure certain psychiatric patients obtain outpatient treatment. While most of the therapy in these outpatient settings involves administration of pharmaceuticals, it does not stretch the imagination to envision that neuromodulation therapies could someday become part of the program.
A study published recently by clinicians at Duke University Medical Center in the American Journal of Psychiatry reported that treatment costs for a group of frequently hospitalized patients declined 50 percent in New York City after the first year of the program, and dropped another 13 percent the second year. Even larger cost savings were reported in five other counties that were part of the analysis.
All but a handful of states have some form of involuntary outpatient commitment program, which requires certain high-risk patients to participate in community-based treatments. But the programs have only been used sporadically in most states. Impediments include concerns about costs, potential coercion of vulnerable people, and liability for patients who harm themselves or others.
In case enforced psychiatric therapy isn’t enough to ponder, news also surfaced of a National Institute on Drug Abuse program to develop an implanted device that eliminates the high achieved by recreational drug users. Researchers at Case Western Reserve and Illinois State universities received a $390,000 grant from NIDA to develop the brain implant. The device senses changes in the dopamine levels when a rat is given addictive substances and suppresses the reward-related signals associated with a pleasurable high.
“The idea is to build a closed-loop microsystem that senses and identifies changes in the dopamine levels induced by drugs of abuse, then activates a stimulator in real time to suppress the reward-related signals that promote drug-seeking behavior,” said CWRU’s Pedram Mohseni, the leader of device development for the research project.
While enforced administration of neuromodulation therapy for psychiatric disorders or for drug addiction may have benefits for society and for the neurotech industry, we should tread very carefully before advocating such a course of action. A host of technological, therapeutic, and legal safeguards would need to be in place before considering it. Otherwise, the potential harm to the industry’s image—and to its user base—might outweigh any short-term gains.