Kevin Y Xu MD MPH
I am a physician-scientist at Washington University, where I completed psychiatry residency on the NIMH R25 research track and recently joined the faculty as a pharmacoepidemiologist in the TranSTAR NIDA T32 program. 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. Outside of my research, I serve as co-director of the PGY2 addiction psychiatry rotation at Washington University.
For My Faculty Webpage: https://psychiatry.wustl.edu/people/kevin-xu-md-mph/
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 racial/ethnic inequities in opioid use disorder treatment
- Deprescribing and prescribing of controlled substances in the elderly
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, and discontinuation rates are extremely high.
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. In Press. 2023.
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.
American Psychiatric Association Foundation
Area-Based Predictors of MOUD Utilization in Pregnancy
My Role: Principal Investigator
Transdisciplinary Training in Addictions Research (TranSTAR) Program
My Role: TranSTAR Scholar
Washington University Psychiatry Residency Research Education Program
My Role: PRREP Fellow