Journal: Journal of Child and Family Studies, 2022, doi: 10.1007/s10826-021-02202-z
Authors: Jennifer L. Matjasko, Gary Chovnick, Joivita Bradford, Sarah Treves-Kagan, Kristen Usher, Elizabeth Vaughn & Erin Ingoldsby
Abstract:
The opioid crisis is a significant challenge for health and human service systems that serve children, youth, and families across the United States. Between 2000 and 2017, the number of foster care entries, a type of adverse childhood experience (ACE), attributable to parental drug use increased by 147%. Nevertheless, there is variation in the burden of opioid overdose and foster care rates across the U.S., suggesting community supports and systems to support families affected by substance use also vary. This qualitative study sampled communities experiencing high and low rates of overdose mortality and foster care entries (i.e., a qualitative comparison group) to better understand what might protect some counties from high overdose mortality and foster care entries. The sample included six counties from three states that were selected based on their rates of opioid overdose mortality and foster care entries. Using purposive sampling within counties, interview and discussion group participants included multi-sector community partners, parents whose children had been removed due to parental substance use, and caregivers caring for children who had been removed from their homes. Across all counties, prevention was not front-of-mind. Yet, participants from communities experiencing high rates of overdose mortality and foster care entries identified several factors that might help lessen exposure to substance use and ACEs including more community-based prevention services for children and youth. Both parents and caregivers across all communities also described the need for additional supports and services. Participants also described the impact of COVID-19 on services, including greater utilization of mental health and substance use treatment services and the challenges with engaging children and youth on virtual platforms. The implications for prevention are discussed, including the need to encourage primary prevention programs in communities.
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Journal: Front. Psychiatry, 2021, doi: 10.3389/fpsyt.2021.786056
Authors: Matthew S. Ellis, Zachary A. Kasper & Stephen Scroggins
Abstract:
Background: Stimulant use among individuals with opioid use disorder has recently increased, driven by changes in drug distribution channels. However, our understanding of polysubstance use is often limited by a need to provide targeted treatment to a primary drug of addiction. Yet there is a crucial need to better understand pathways to addiction, and how the use of multiple substances may differ between populations, as well as time periods.
Methods: Using a national opioid surveillance system, we analyzed survey data from new entrants to 124 opioid use disorder treatment centers from 2017 to 2020. Age of first use was collected for prescription opioids, illicit opioids, prescription stimulants, crack/cocaine, and methamphetamines. Year of initial use of an opioid or stimulant was calculated and grouped by 5 year blocs, inclusive of initial use starting from 1991 and ending in 2020 (n = 6,048).
Results: Lifetime exposure to stimulants was 82.5% among individuals with opioid use disorder. Mean age of initiation increased for all drugs in 2016–2020, in particular prescription opioids (22.3 to 31.8). Stimulants were initiating drugs for a substantial proportion of individuals with opioid use throughout the analyzed time period. Those initiating opioid/stimulant use from 1991 to 1995 had a mean average of 6.8 years between first and second drug exposure, which steadily decreased to 1.5 years between exposures in 2016–2020. Sankey plots depict significantly more drug transitions in those initiating use from 1991 to 2000 (65.1% had at least two drug transitions) compared to 2010–2020 (16.0%). Opioid-stimulant use increased over time among racial/ethnic minorities, sexual minorities, and those with an educational attainment of high school or less.
Conclusion: These data highlight not only the substantial prevalence of stimulant use among individuals who develop opioid use disorder, but also the variability through which pathways of use occur. Prevention and intervention efforts need to take into account increasing ages of initial drug exposures, demographic shifts in stimulant-using populations, and more rapid drug transitions between opioid and stimulants. But at a broader level, prevention, harm reduction ideology, and addiction medicine needs to take into account the ubiquity of polysubstance use among individuals with substance use disorders.
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Journal: Addictive Behaviors, 2022, doi: 10.1016/j.addbeh.2021.107213
Authors: Navin Kumar, Kamila Janmohamed, Kate Nyhan, Silvia S. Martins, Magdalena Cerda, Deborah Hasin, Jenny Scott, Afia Sarpong Frimpong, Richard Pates, Lilian A. Ghandour, Mayyada Wazaify & Kaveh Khoshnood
Abstract:
Background: We conducted a scoping review focused on various forms of substance use amid the pandemic, looking at both the impact of substance use on COVID-19 infection, severity, and vaccine uptake, as well as the impact that COVID-19 has had on substance use treatment and rates.
Methods: A scoping review, compiling both peer-reviewed and grey literature, focusing on substance use and COVID-19 was conducted on September 15, 2020 and again in April 15, 2021 to capture any new studies. Three bibliographic databases (Web of Science Core Collection, Embase, PubMed) and several preprint servers (EuropePMC, bioRxiv, medRxiv, F1000, PeerJ Preprints, PsyArXiv, Research Square) were searched. We included English language original studies only.
Results: Of 1564 articles screened in the abstract and title screening phase, we included 111 research studies (peer-reviewed: 98, grey literature: 13) that met inclusion criteria. There was limited research on substance use other than those involving tobacco or alcohol. We noted that individuals engaging in substance use had increased risk for COVID-19 severity, and Black Americans with COVID-19 and who engaged in substance use had worse outcomes than white Americans. There were issues with treatment provision earlier in the pandemic, but increased use of telehealth as the pandemic progressed. COVID-19 anxiety was associated with increased substance use.
Conclusions: Our scoping review of studies to date during COVID-19 uncovered notable research gaps namely the need for research efforts on vaccines, COVID-19 concerns such as anxiety and worry, and low- to middle-income countries (LMICs) and under-researched topics within substance use, and to explore the use of qualitative techniques and interventions where appropriate. We also noted that clinicians can screen and treat individuals exhibiting substance use to mitigate effects of the pandemic.
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Journal: PLOS ONE, 2021, doi: 10.1371/journal.pone.0258723
Authors: Ying Chen, Christina Hinton & Tyler J. VanderWeele
Abstract:
While past empirical studies have explored associations between types of primary and secondary schools and student academic achievement, outcomes beyond academic performance remain less well-understood. Using longitudinal data from a cohort of children (N = 12,288, mean age = 14.56 years) of nurses, this study examined associations between the types of schools participants attended in adolescence and a wide range of subsequent psychological well-being, social engagement, character strengths, mental health, health behavior and physical health outcomes. Results in this sample suggested little difference between attending private independent schools and public schools across outcomes in young adulthood. There were, however, notable differences in subsequent outcomes comparing homeschooling and public schools, and possibly some evidence comparing religious schools and public schools. Specifically, there was some evidence that attending religious schools versus public schools was associated with a higher likelihood of frequent religious service attendance and becoming registered voters, a lower risk of overweight/obese, fewer lifetime sexual partners, and a higher risk of subsequently being binge drinkers; however, these associations were not robust to correction for multiple testing. Homeschooling compared with public schooling was associated with subsequently more frequent volunteering (ß = 0.33, 95% CI = 0.15, 0.52), greater forgiveness (ß = 0.31, 95% CI = 0.16, 0.46), and more frequent religious service attendance (Risk Ratio [RR] = 1.51, 95% CI: 1.27, 1.80), and possibly also with greater purpose in life, less marijuana use, and fewer lifetime sexual partners, but negatively associated with college degree attainment (RR = 0.77, 95% CI: 0.67, 0.88) and possibly with greater risk of posttraumatic stress disorder. These results may encourage education stakeholders to consider a wider range of outcomes beyond academic performance in decision-making.
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Journal: International Journal of Environmental Research and Public Health, 2021, doi: 10.3390/ijerph182412985
Authors: Adriana Pérez, Arnold E. Kuk, Meagan A. Bluestein, Hui Min Shirlyn Sia & Baojiang Chen
Abstract:
Earlier exposure to binge drinking and tobacco use is associated with higher odds of substance use disorders. Using national youth data from the PATH study, we prospectively estimate the age of initiating past 30-day use of (1) cigarettes, e-cigarettes, and binge drinking, and (2) cigarettes, cigarillos, and binge drinking. Cox proportional hazard models were used to estimate differences in the age of initiation by sex, race/ethnicity, and previous use of other tobacco products. By age 21, 4.4% (95% CI: 3.7–5.2) and 2.0% (95% CI: 1.2–2.8) of youth reported initiation of past 30-day use outcomes (1) and (2), respectively. After controlling for sex and previous use of other tobacco products, statistically significant differences in the age of initiation by race/ethnicity were found for each outcome: Hispanic and non-Hispanic Black youth were less likely than non-Hispanic White youth to initiate past 30-day use of both outcomes (1) and (2) at earlier ages. Although the initiation of both outcomes remained relatively low by age 21, these incidences represent 1.56 million and 700,000 youth, respectively. This study provides the public with evidence to identify the particular ages at which education campaigns may be most effective to prevent youth from initiating these three substances. Further research is needed to estimate the age of initiation of other dual tobacco use patterns with binge drinking.
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