Kevin Y Xu MD MPH
I am a physician-scientist at Wash U, where I completed psychiatry residency on the NIMH R25 research track, joined the faculty as a pharmacoepidemiologist in the TranSTAR NIDA T32 program (June 2022-June 2023), and recently received a NIDA K12 award (beginning July 2023). My research uses administrative claims to test how clinical trial findings generalize to the real world, especially in populations underrepresented in substance use disorders research. I have a particular interest in addiction treatment gaps in pregnancy and the rational deprescribing and prescribing of controlled substances. My work has been published in journals such as the American Journal of Psychiatry, Obstetrics & Gynecology, and multiple JAMA network publications.
For My Faculty Webpage: https://psychiatry.wustl.edu/people/kevin-xu-md-mph/
Email: xukeviny@wustl.edu
Education and Training:
- Residency: NIMH R25 Research Pathway, Washington University, St. Louis, MO, 2022
- MD/MPH: Icahn School of Medicine at Mount Sinai, New York, NY, 2018
- BA: Columbia University, New York, NY, 2014
Research Areas of Interest:
- Comparative effectiveness of medication to treat opioid use disorder in pregnancy
- Evaluating the risks and benefits of benzodiazepines, stimulants, and gabapentin in people with substance use disorders
- Using administrative data to better understand inequities in opioid use disorder treatment
- Deprescribing and prescribing of controlled substances in the elderly
Selected Publications:
Pregnant status is associated with increases in buprenorphine and methadone utilization. Nonetheless, most reproductive-age women in the U.S. with opioid use disorder do not receive buprenorphine or methadone. At 6 months, most people were not retained in treatment.
Kevin Y Xu, Hendrée E Jones, Davida M Schiff, Caitlin E Martin, Jeannie C Kelly, Ebony B Carter, Laura J Bierut, Richard A Grucza. Medication Initiation and Treatment Discontinuation in Pregnant Compared With Nonpregnant People. Obstetrics & Gynecology. 2023 Apr 1;141(4):845-853. PMID: 36970994
Illustrative of the racialized origins of buprenorphine and methadone, we observed significant racial disparities in OUD receipt during pregnancy, such that non-Hispanic Black reproductive-age women were more likely to receive methadone, less likely to receive buprenorphine, and less likely to be retained in treatment for both, compared to non-Hispanic White peers.
Kevin Y Xu, Davida M Schiff, Hendrée E Jones, Caitlin E Martin, Jeannie C Kelly, Laura J Bierut, Ebony B Carter, Richard A Grucza. Racial and Ethnic Inequities in Buprenorphine and Methadone Utilization Among Reproductive-Age Women with Opioid Use Disorder: An Analysis of Multi-State Medicaid Claims in the USA. Journal of General Internal Medicine. 2023 Jul 12. (*=denoting equal contribution.)
Gabapentin is increasingly detected in opioid-related overdoses. We used administrative claims to show that gabapentin’s association with overdoses does not necessarily mean that it causes overdoses in people with opioid use disorder.
Matthew S Ellis*, Kevin Y Xu*, Vitor S Tardelli, Thiago M Fidalgo, Mance E Buttram, Richard A Grucza. Gabapentin and Drug-Related Overdoses in the United States (2006-2016). JAMA Psychiatry. 2023. In Press. (*=denoting equal contribution.)
We are seeing increased comorbidity between opioid and stimulant use disorders (i.e., methamphetamines). We found that having a co-occurring stimulant use disorder does not necessarily render a patient with OUD and ADHD too “risky” to derive benefit from psychostimulants.
Vitor S Tardelli*, Kevin Y Xu*, Adam Bisaga, Frances R Levin, Thiago M Fidalgo*, Richard A Grucza*. ADHD Medication in People with Co-Occurring Opioid and Stimulant Use Disorder: An Analysis of Adverse Event Risk. BMJ Mental Health. 2023. In Press. (*=denoting equal contribution.)
Benzodiazepines have long been the subject of gendered cultural connotations, evidenced by diazepam’s immortalization in popular culture as “Mother’s Little Helper.” In an analysis of national insurance claims, we observed a significantly higher prescribing burden among female than male patients with opioid use disorder, raising concerns for gender-based disparities in prescribing.
Caitlin E Martin, Hetal Patel, Joseph M Dzierewski, F Gerard Moeller, Laura J Bierut, Richard A Grucza, Kevin Y Xu. Benzodiazepine, Z-Drug and Sleep Medication Prescriptions in Male and Female People with Opioid Use Disorder on Buprenorphine and Comorbid Insomnia: An Analysis of Multi-State Insurance Claims. Sleep. 2023 Mar 27:zsad083. PMID: 36897142
Polysubstance use is understudied in substance use disorders research, even though it is increasingly the rule rather than the exception in people with OUD. Buprenorphine is underutilized in those with OUD and polysubstance use, even though it exhibits protective effects against overdose that are equally strong in people with and without polysubstance use.
Kevin Y Xu, Ned Presnall, Carrie M Mintz, Laura J Bierut, Richard A Grucza. Comparative effectiveness of buprenorphine and naltrexone in opioid use disorder and co-occurring substance use disorders. JAMA Network Open. 2022. 5(5):e2211363. PMCID: PMC9092203
ADHD is prevalent in people with substance use disorders, but the risks and benefits of prescription stimulants are poorly understood in this patient population. We found that prescription stimulants to treat ADHD are associated with a small increase in drug-related poisoning risk in people with OUD, but stimulants also confer strong improvements in buprenorphine retention.
Carrie M Mintz*, Kevin Y Xu,* Ned Presnall, Sarah M Hartz, Frances R Levin, Laura J Bierut, Richard A Grucza. Associations between stimulant prescriptions and drug overdose risk in persons in treatment for opioid use disorder. JAMA Network Open. 2022. 5(5):e2211634. (*=denoting equal contribution).
The real-world risks of benzodiazepine and buprenorphine co-use are poorly characterized, even though sedative/hypnotic are very commonly prescribed in people receiving buprenorphine maintenance. We found that despite increased drug-related poisoning risk conferred by benzodiazepines, they do not “undo” the protective effect of buprenorphine when taken simultaneously.
Kevin Y Xu, Jacob T Borodovsky, Ned Presnall, Carrie M Mintz, Sarah M Hartz, Laura J Bierut, Richard A Grucza. Association between benzodiazepine or Z-drug prescriptions and drug-related poisonings among patients receiving buprenorphine maintenance. American Journal of Psychiatry. 2021.
Structural racism is endemic in clinical psychiatry. We have published work on how the translation of antiracist knowledge into everyday clinical care can potentially be hindered by physicians holding racial biases independent of and often in opposition to conscious antiracist attitudes.
Tashalee R Brown, Kevin Y Xu, Anne L Glowinski. Cognitive Behavioral Therapy and the Implementation of Antiracism. JAMA Psychiatry. 2021.
Funding:
K12 DA041449 (Beginning 7/1/2023)
NIDA K12 Career Development Award Program in Substance Use and Substance Use Disorders
My Role: K12 Scholar
Center for Perioperative Mental Health R03 Pilot and Feasibility Award (6/1/2024-5/30/2025)
Using Big Data to Elucidate Perioperative Benzodiazepine Receptor Agonist and Opioid Prescribing in Older Adults
My Role: Principal Investigator
WU ICTS Collaborative Administrative Data Research Award (4/17/2023-4/16/2024)
Using Administrative Data to Study Contraceptive Uptake in Postpartum Women with Opioid Use Disorder
My Role: Co-Principal Investigator (with Jennifer Bello Kottenstette MD MS)
American Psychiatric Association Foundation (7/1/2022-6/30/2024)
Area-Based Predictors of MOUD Utilization in Pregnancy
My Role: Principal Investigator
T32 DA015035-12, (6/15/2022-6/30/2023)
Transdisciplinary Training in Addictions Research (TranSTAR) Program
My Role: TranSTAR Scholar
R25 MH112473-01 (7/1/2018-6/15/2022)
Washington University Psychiatry Residency Research Education Program
My Role: PRREP Fellow