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Ball A, Hadland S, Rodean J, Hall M, Mendoza J, Ahrens K. Trends in Substance-Related Visits Among Youth to US Children's Hospitals, 2016-2021: An Analysis of the Pediatric Health Information System Database. J Adolesc Health 2024; 75:76-84. [PMID: 38530681 DOI: 10.1016/j.jadohealth.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE This study evaluates recent trends in substance-related visits among youth visiting children's hospitals. METHODS We conducted a cross-sectional study of substance-related visits to pediatric hospitals within the Pediatric Health Information System database of youth aged 12-21 years from 2016 through 2021. Substance-related visits were defined as acute visits for International Classification of Diseases, 10th Revision Clinical Modification codes related to substance 'use', dependence, or overdoses for alcohol, cannabis, nicotine, opioids, sedatives, stimulants, hallucinogens, or other substances. Cumulative growth rate and stratified substance-related trends were calculated using generalized estimating equations. Predicted number of visits during the COVID-19 pandemic was generated using an auto-regressive time series analysis. RESULTS There were 106,793 substance-related visits involving 84,632 youth. From 2016 to 2021, substance-related visits increased by 47.9% and increased across all ages, demographics, regions, and payors. Visits of Hispanic youth experienced the greatest percentage growth (63.3%, p < .05) when compared to Non-Hispanic (NH) White (46.2%) or NH Black (49.8%) youth. All substances except sedatives experienced an increase in growth in visits. Cannabis accounted for the largest percentage of visits (52.2%) and experienced the greatest percentage growth during the study period (82.4%, p < .001). During the pandemic, publicly insured, female, NH Black, and Hispanic youth experienced a greater-than-predicted number of substance-related visits. DISCUSSION Substance-related visits to children's hospitals are increasing for all demographics and nearly all substances. There were substantial increases in visits for most minoritized youth with a disproportionate rise among Hispanic youth. Visits over the pandemic were concentrated among publicly insured, female, NH Black, and Hispanic youth. Equitable large-scale investment is needed to address the rising morbidity of substance use among adolescents.
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Affiliation(s)
- Alexis Ball
- Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, Washington.
| | - Scott Hadland
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Mass General Hospital/Harvard Medical School, Boston, Massachusetts
| | | | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Jason Mendoza
- Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, Washington; Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kym Ahrens
- Division of Adolescent Medicine, Department of Pediatrics, Seattle Children's Hospital/University of Washington, Seattle, Washington
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Yeo EJ, Hausman E, Noyes E, Chatterjee A. Evaluating mobile harm reduction services for youth and young adults. Front Public Health 2024; 12:1375323. [PMID: 38841665 PMCID: PMC11150819 DOI: 10.3389/fpubh.2024.1375323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
The adolescent and young adult (AYA) population has experienced an increase in both emergency room visits and deaths related to substance use. However, AYA are less likely to engage in existing addiction treatment infrastructure. A youth-specific mobile harm reduction program has the potential to reduce substance-related morbidity and mortality including infections, overdose, and death. Launched in 2019, the Community Care in Reach AYA pilot program seeks to address the difference in patterns of substance use between AYA and adults. The results of this evaluation suggest the importance of a youth-oriented program in increasing AYA engagement with harm reduction.
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Affiliation(s)
- Ellis J. Yeo
- Harvard Medical School, Boston, MA, United States
| | - Elizabeth Hausman
- College of Social Work, University of Kentucky, Lexington, KY, United States
| | - Elizabeth Noyes
- Department of Otolaryngology-Head and Neck Surgery, Mass Eye and Ear, Boston, MA, United States
| | - Avik Chatterjee
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States
- Boston Health Care for the Homeless Program, Boston, MA, United States
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Trinh CD, Girard R, Schick MR, Spillane NS. Positive psychological interventions on alcohol use and consequences: Pilot randomized trial in a young adult cannabis-using sample. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209241. [PMID: 38056630 DOI: 10.1016/j.josat.2023.209241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/18/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Young adults exhibit high rates of concurrent alcohol and cannabis use, which is associated with more negative alcohol-related consequences. Positive psychological interventions have successfully been leveraged to target alcohol, cannabis, and nicotine use, as well as substance use disorders, and may be a useful harm reduction approach to reduce alcohol-related consequences. This pilot study sought to generate effect sizes for two positive psychological interventions, Savoring and Three Good Things, on frequency of alcohol use, quantity of alcohol use, and alcohol-related consequences. METHODS The current study used data from a pilot study testing positive psychological interventions to reduce cannabis use and cannabis-related consequences in young adults (ages 18 to 25) who used cannabis at least once per week within the prior month (N = 50, Mage = 22.72, 72 % men, 40 % White). Participants reported baseline alcohol and cannabis use and alcohol-related consequences, then the study randomized them to complete a daily Savoring intervention, Three Good Things, or a control exercise, and completed daily text message surveys for two weeks (i.e., the intervention period) and a follow-up survey. RESULTS Analyses revealed no significant differences across experimental conditions on alcohol use frequency, alcohol use quantity, or alcohol-related consequences at baseline or follow-up. Paired samples t-tests demonstrated that participants in the Savoring group showed large, significant decreases in alcohol-related consequences (t[16] = 2.28, p = .04, gav = 0.54); no decreases occurred in frequency or quantity of alcohol use. The Three Good Things group showed no significant decreases in alcohol-related consequences, frequency of alcohol use, or quantity of alcohol use. CONCLUSIONS Results suggest that a larger scale clinical trial is warranted to determine whether Savoring and Three Good Things might function as harm reduction interventions to reduce alcohol-related consequences in young adults who concurrently use alcohol and cannabis. Future research should use a larger sample, a longer intervention administration period, and a longer follow-up period to examine these positive psychological interventions more rigorously.
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Affiliation(s)
- Catherine D Trinh
- University of Rhode Island, Department of Psychology, Kingston, RI 02881, USA
| | - Rachel Girard
- University of Rhode Island, Department of Psychology, Kingston, RI 02881, USA
| | - Melissa R Schick
- Yale School of Medicine, Division of Prevention and Community Research, New Haven, CT 06511, USA
| | - Nichea S Spillane
- University of Rhode Island, Department of Psychology, Kingston, RI 02881, USA.
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de Saxe Zerden L, Ware OD, Lombardi BN, Lombardi BM. Harm reduction workforce, behavioral health, and service delivery in the USA: a cross-sectional study. Harm Reduct J 2024; 21:36. [PMID: 38336662 PMCID: PMC10858514 DOI: 10.1186/s12954-024-00952-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Despite recent financial and policy support for harm reduction in the USA, information on the types of workers within organizations who design, implement, and actualize harm reduction services remains nascent. Little is known about how variability in the harm reduction workforce impacts referrals and linkages to other community supports. This exploratory mixed-methods study asked: (1) Who constitutes the harm reduction workforce? (2) Who provides behavioral health services within harm reduction organizations? (3) Are referral services offered and by whom? (4) Do referrals differ by type of harm reduction worker? METHODS Purposive sampling techniques were used to distribute an electronic survey to U.S.-based harm reduction organizations. Descriptive statistics were conducted. Multivariate binary logistic regression models examined the associations (a) between the odds of the referral processes at harm reduction organizations and (b) between the provision of behavioral health services and distinct types of organizational staff. Qualitative data were analyzed using a hybrid approach of inductive and thematic analysis. RESULTS Data from 41 states and Washington, D.C. were collected (N = 168; 48% response rate). Four primary types of workers were identified: community health/peer specialists (87%); medical/nursing staff (55%); behavioral health (49%); and others (34%). About 43% of organizations had a formal referral process; among these, only 32% had follow-up protocols. Qualitative findings highlighted the broad spectrum of behavioral health services offered and a broad behavioral health workforce heavily reliant on peers. Unadjusted results from multivariate models found that harm reduction organizations were more than 5 times more likely (95% CI [1.91, 13.38]) to have a formal referral process and 6 times more likely (95% CI [1.74, 21.52]) to have follow-up processes when behavioral health services were offered. Organizations were more than two times more likely (95% CI [1.09, 4.46]) to have a formal referral process and 2.36 (95% CI [1.11, 5.0]) times more likely to have follow-up processes for referrals when behavioral health providers were included. CONCLUSIONS The composition of the harm reduction workforce is occupationally diverse. Understanding the types of services offered, as well as the workforce who provides those services, offers valuable insights into staffing and service delivery needs of frontline organizations working to reduce morbidity and mortality among those who use substances. Workforce considerations within U.S.-based harm reduction organizations are increasingly important as harm reduction services continue to expand.
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Affiliation(s)
- Lisa de Saxe Zerden
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St. CB #3550, Chapel Hill, NC, 27599, USA.
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Orrin D Ware
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St. CB #3550, Chapel Hill, NC, 27599, USA
| | - Brooke N Lombardi
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Brianna M Lombardi
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St. CB #3550, Chapel Hill, NC, 27599, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Pueyo-Garrigues S, Pardavila-Belio MI, Pueyo-Garrigues M, Canga-Armayor N. Peer-led alcohol intervention for college students: A pilot randomized controlled trial. Nurs Health Sci 2023; 25:311-322. [PMID: 37271216 DOI: 10.1111/nhs.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023]
Abstract
This study aims to assess the preliminary efficacy and feasibility of a brief, peer-led alcohol intervention to reduce alcohol consumption in binge-drinking Spanish nursing students. A pilot randomized controlled trial was conducted with 50 first-year nursing students who were randomly assigned either a 50-min peer-led motivational intervention with individual feedback or a control condition. Primary outcomes for testing the preliminary efficacy were alcohol use and alcohol-related consequences. Quantitative and content analyses of open-ended survey questions were performed. Participants in the intervention condition significantly reduced binge-drinking episodes, peak blood alcohol content, and consequences compared to the control group. Principal facilitators were completing the questionnaire during the academic schedule and providing tailored feedback through a graphic report. The main barrier was the unreliability of students' initial commitment. The findings suggest that a brief motivational intervention could be effective for reducing alcohol consumption and alcohol-related consequences in Spanish college students. Peer counselors and participants reported high satisfaction, indicating that the intervention is feasible. However, a full trial should be conducted taking into account the identified barriers and facilitators.
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Affiliation(s)
| | - Miren Idoia Pardavila-Belio
- School of Nursing, Community, Maternity and Pediatric Nursing, University of Navarra, Pamplona, Spain
- IdiSNa, Navarra Institute for Health Research, Pamplona, Spain
| | - María Pueyo-Garrigues
- School of Nursing, Community, Maternity and Pediatric Nursing, University of Navarra, Pamplona, Spain
- IdiSNa, Navarra Institute for Health Research, Pamplona, Spain
| | - Navidad Canga-Armayor
- School of Nursing, Community, Maternity and Pediatric Nursing, University of Navarra, Pamplona, Spain
- IdiSNa, Navarra Institute for Health Research, Pamplona, Spain
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Abstract
PURPOSE OF REVIEW Adolescent and young adult overdoses and overdose fatalities continue to increase despite reductions in self-reported substance use. This review aims to explore factors contributing to this overdose epidemic, highlight signs of overdose and the role of the overdose reversal medication naloxone, and provide recommendations for practice change to support patients and decrease their risk of unintentional overdose. RECENT FINDINGS The potent opioid fentanyl is a common contaminant in nonopioid substances, as well as in heroin and counterfeit pills, heightening risk of fatal overdose. Adolescents and young adults who die of overdose are rarely engaged in substance use disorder treatment. Medications for opioid use disorder are effective at reducing risk of fatal overdose but are underutilized, as is the opioid reversal medication naloxone. SUMMARY Pediatric clinician engagement in harm reduction with adolescents and young adults, starting with screening through a confidential interview, may enhance pathways to care and reduce the risk of overdose.
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Affiliation(s)
- Lauren A. Bell
- Division of Adolescent Medicine and Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN
| | - Scott E. Hadland
- Division of Adolescent and Young Adult Medicine Massachusetts General Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
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Kreim S, Marchand K, Mallia E, Dubras R, McMaster WR, Tee K, Mathias S, Barbic S. Identifying early intervention opportunities for illicit stimulant use: A cross-sectional study of factors associated with illicit stimulant use among young people accessing integrated youth services in British Columbia, Canada. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023:209076. [PMID: 37182544 DOI: 10.1016/j.josat.2023.209076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/12/2022] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Illicit stimulant (cocaine and/or amphetamine) use among young people aged 12-24 is a public health priority given that substance use initiation tends to peak in this developmental period and significant associated immediate and long-term harms are associated with its use. Young people using stimulants must be engaged in services as early as possible to reduce these harms. To inform early intervention opportunities, this study aimed to identify the risk/protective factors associated with illicit stimulant use among young people. METHODS We conducted a cross-sectional study on routinely collected self-reported data among young people accessing integrated youth services in British Columbia (Canada) between April 2018 and January 2022. Data were collected on young peoples' socio-demographic characteristics, and social, behavioral, and health profiles. Variable selection was guided by established risk/protective factors for substance use among young people. The study used multivariable logistic regression to identify risk/protective factors that were independently associated with past 30-day illicit stimulant use. RESULTS The analytic sample included n = 5620 young people aged 12-24 and a total of 163 (2.9 %) reported past 30-day illicit cocaine and/or amphetamine use. Demographic characteristics that were independently associated with illicit stimulant use included older age (aOR = 1.27, 95 % CI = 1.17-1.38) and gender identity as man vs woman (aOR = 1.71, 95 % CI = 1.10-2.70). Social and environmental risk factors included recently witnessing or experiencing violence (aOR = 2.32, 95 % CI = 1.47-3.68) and higher past-year crime/violent behaviors score (aOR = 1.39, 95 % CI = 1.13-1.69). Finally, regular alcohol (aOR = 6.90, 95 % CI = 2.36-25.42), regular (aOR = 3.74, 95 % CI = 1.95-7.54) or social (aOR = 3.06, 95 % CI = 1.44-6.60) tobacco use, and lifetime hallucinogen (aOR = 3.24, 95 % CI = 1.8-5.91) and ecstasy/MDMA (aOR = 2.53, 95 % CI = 1.48-4.39) use were also statistically significant risk factors. CONCLUSIONS These risk/protective factors support identification of young people who may benefit from further screening, assessment, and treatment for illicit stimulant use. This study also underscores the need to expand early intervention and harm reduction programs that can comprehensively respond to young peoples' stimulant use, health, and social needs.
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Affiliation(s)
- Sara Kreim
- Faculty of Science, University of British Columbia, 2207 Main Mall, Vancouver, BC V6T 1Z4, Canada
| | - Kirsten Marchand
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| | - Emilie Mallia
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Richard Dubras
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - W Robert McMaster
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201-4500 Oak Street, Vancouver, BC V6H3N1, Canada
| | - Karen Tee
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Steve Mathias
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Providence Research, 1190 Hornby Street, Vancouver, BC V6Z 1Y6, Canada; Department of Psychiatry, 2255 Wesbrook Mall, University of British Columbia, Vancouver, BC V6T 2A1, Canada
| | - Skye Barbic
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Providence Research, 1190 Hornby Street, Vancouver, BC V6Z 1Y6, Canada
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O'Brien D, Hudson-Breen R. "Grasping at straws," experiences of Canadian parents using involuntary stabilization for a youth's substance use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104055. [PMID: 37182351 DOI: 10.1016/j.drugpo.2023.104055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND In Canada, involuntary stabilization programs are used to apprehend and confine youth who use drugs for the purpose of stabilization, assessment, and discharge planning. In the Canadian province of Alberta, the Protection of Children Using Drugs (PChAD) act allows parents to apply for involuntary stabilization of their children for up to 15 days. Given that research on involuntary stabilization programs is scarce, this qualitative study was designed to explore parents' experiences with PChAD and their perceptions of the program's benefits and drawbacks. METHODS We conducted semi-structured interviews with 18 parents who had used PChAD for their children between 2007-2018. Interviews were conducted between 2019-2020 and were analyzed inductively using Interpretive Phenomenological Analysis. RESULTS Most parents sought involuntary stabilization because they were desperate to protect their child's health and safety, or to motivate them to reduce their substance use. Many also felt lost and overwhelmed because their child was unwilling to attend voluntary treatment, and they lacked professional guidance as to how to care for their child. Consequently, many parents used involuntary stabilization because they did not know what else to do. While some parents were grateful to have their child temporarily safe, many were disappointed because involuntary stabilization had little impact on their child's substance use. Parents also felt they did not receive sufficient support in coordinating their child's care following involuntary stabilization. Parents identified several risks of involuntary stabilization, such as angering the youth and undermining trust, and exposing them to negative peer influences. IMPLICATIONS It is important for policymakers and clinicians to carefully consider whether the immediate benefits of keeping youth safe are worth the potential risks. Efforts are needed to provide families with greater guidance and support, and to ensure coordinated access to a continuum of voluntary services, including treatment and harm reduction.
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Affiliation(s)
- Daniel O'Brien
- University of Alberta, Faculty of Education, Department of Educational Psychology 6-102 Education North, University of Alberta, Edmonton, AB T6G 2G5, Canada.
| | - Rebecca Hudson-Breen
- University of Alberta, Faculty of Education, Department of Educational Psychology 6-102 Education North, University of Alberta, Edmonton, AB T6G 2G5, Canada
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CERDÁ MAGDALENA, KRAWCZYK NOA, KEYES KATHERINE. The Future of the United States Overdose Crisis: Challenges and Opportunities. Milbank Q 2023; 101:478-506. [PMID: 36811204 PMCID: PMC10126987 DOI: 10.1111/1468-0009.12602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Policy Points People are dying at record numbers from overdose in the United States. Concerted action has led to a number of successes, including reduced inappropriate opioid prescribing and increased availability of opioid use disorder treatment and harm-reduction efforts, yet ongoing challenges include criminalization of drug use and regulatory and stigma barriers to expansion of treatment and harm-reduction services. Priorities for action include investing in evidence-based and compassionate policies and programs that address sources of opioid demand, decriminalizing drug use and drug paraphernalia, enacting policies to make medication for opioid use disorder more accessible, and promoting drug checking and safe drug supply.
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Affiliation(s)
- MAGDALENA CERDÁ
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
| | - NOA KRAWCZYK
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
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Monarque M, Sabetti J, Ferrari M. Digital interventions for substance use disorders in young people: rapid review. Subst Abuse Treat Prev Policy 2023; 18:13. [PMID: 36805783 PMCID: PMC9937742 DOI: 10.1186/s13011-023-00518-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/26/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Young people are disproportionately more likely than other age groups to use substances. The rise in substance use and related harms, including overdose, during the Covid-19 pandemic has created a critical need for more innovative and accessible substance use interventions. Digital interventions have shown effectiveness and can provide more engaging, less stigmatizing, and accessible interventions that meet the needs of young people. This review provides an overview of recent literature on the nature of recently published digital interventions for young people in terms of technologies used, substances targeted, intended outcomes and theoretical or therapeutic models employed. METHODS Rapid review methodology was used to identify and assess the literature on digital interventions for young people. An initial keyword search was conducted using MEDLINE the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTA) and PROSPERO for the years 2015-2020, and later updated to December 2021. Following a title/abstract and full-text screening of articles, and consensus decision on study inclusion, the data extraction process proceeded using an extraction grid developed for the study. Data synthesis relied on an adapted conceptual framework by Stockings, et al. that involved a three-level treatment spectrum for youth substance use (prevention, early intervention, and treatment) for any type of substance. RESULTS In total, the review identified 43 articles describing 39 different digital interventions. Most were early interventions (n = 28), followed by prevention interventions (n = 6) and treatment interventions (n = 5). The identified digital technologies included web-based (n = 14), game-based (n = 10), mobile-based (n = 7), and computer-based (n = 5) technologies, and virtual reality (n = 3). Most interventions targeted alcohol use (n = 20) followed by tobacco/nicotine (n = 5), cannabis (n = 2), opioids (n = 2), ketamine (1) and multiple, or any substances (n = 9). Most interventions used a personalized or normative feedback approach and aimed to effect behaviour change as the intended outcome. Interestingly, a harm reduction approach guided only one of the 39 interventions. CONCLUSIONS While web-based interventions represented the most common type of technology, more recently developed immersive and interactive technologies such as virtual reality and game-based interventions call for further exploration. Digital interventions focused mainly on alcohol use, reflecting less concern for tobacco, cannabis, co-occurring substance use, and illicit drug use. Specifically, the recent exacerbation in the opioid crisis throughout North American underlines the urgent need for more prevention-oriented digital interventions for opioid use. The uptake of digital interventions among youth also depends on the incorporation of harm reduction approaches.
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Affiliation(s)
- Marika Monarque
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Judith Sabetti
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Manuela Ferrari
- Douglas Mental Health University Institute, Montreal, QC, Canada.
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Douglas Hospital Research Centre, 6875 Boulevard LaSalle, Perry C3 E-3102, QC H4H 1R3, Montreal, Canada.
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Moebes ZR, Card KG, Koenig B, Benoit C. Lower-risk substance use guidelines accessible by youth. Subst Abuse Treat Prev Policy 2023; 18:10. [PMID: 36782291 PMCID: PMC9926657 DOI: 10.1186/s13011-023-00516-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/09/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Lower-risk substance use guidelines (LRSUGs) are an evidence-based harm reduction strategy used to provide information to people who use drugs so they can reduce harms associated with substance use. OBJECTIVES This study aimed to identify LRSUGs accessible to youth and to characterize the recommendations within these guidelines. The overall goal is to identify gaps in current LRSUGs and to inform researchers and policymakers of the kinds of health information youth can access. METHODS We conducted a digital assessment using the Google search engine to identify LRSUGs that could be identified by youth when searching for official sources of information related to commonly used substances, including cannabis, caffeine, alcohol, hallucinogens, prescription opioids, nicotine, and/or prescription stimulants. LRSUGs were coded and data were extracted from them to identify gaps. RESULTS One hundred thirty LRSUGs were identified; most focused on alcohol (n = 40, 31%), cannabis (n = 30, 23%), and caffeine (n = 21, 16%). LRSUGs provided recommendations about dosing (n = 108, 83%), frequency of use (n = 72, 55%), and when to use (n = 86, 66%). Most LRSUGs were published by health (n = 51, 39%) and third-sector organizations (n = 41, 32%), followed by provincial/state (n = 18, 14%), government (n = 14, 11%), municipal (n = 4, 3%), and academic (n = 2, 2%) sources. Only 16% (n = 21) of LRSUGs were youth-specific and one-quarter (n = 32, 25%) of LRSUGs provided gender-specific recommendations. Most guidelines featured information on short (n = 76, 58%) and long-term (n = 69, 53%) negative effectives and positive effects of substances (n = 56, 43%). Less than half (n = 50, 38%) of LRSUGs cited evidence in support of the information they provided. CONCLUSIONS We identified several areas in the current LRSUGs for youth that need to be addressed. Among the gaps are a lack of LRSUGs developed specifically for youth, a lack of youth engagement in developing harm reduction strategies centered around them, and a lack of evidence-based LRSUGs. Youth-oriented, evidence-based LRSUGs are needed to better support youth who use substances and help them manage the negative effects of substance use.
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Affiliation(s)
- Zakkaery R. Moebes
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, BC Victoria, Canada
| | - Kiffer G. Card
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, BC Victoria, Canada
- grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Brett Koenig
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, BC Victoria, Canada
| | - Cecilia Benoit
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, BC Victoria, Canada
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Dernbach MR, Gray KM, Borich A, Seery E, Russo SB, Lewis ET, Gwynette MF. Prescribing Stimulants for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder and Co-occurring Cannabis Use: Considerations for Managing a Clinical Dilemma. J Am Acad Child Adolesc Psychiatry 2023:S0890-8567(23)00055-2. [PMID: 36773700 DOI: 10.1016/j.jaac.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/02/2022] [Accepted: 11/02/2022] [Indexed: 02/11/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is highly prevalent in the pediatric population, with 11% of children and adolescents having ever been diagnosed with the disorder.1 The management of ADHD in the setting of co-occurring cannabis use, which is more prevalent in adolescents with ADHD than in the general population, is an increasingly common dilemma facing clinicians, in part due to recent changes in social acceptability, access, usage, and state-level legal status of cannabis.2 Clinicians face several considerations, including the following: the confounding effects of cannabis use on assessment and management of ADHD symptoms; the potential reduction in risk of substance use when ADHD symptoms are well managed; and the increased risk of misuse and diversion of stimulants in patients with ongoing cannabis use.2.
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Affiliation(s)
| | - Kevin M Gray
- Medical University of South Carolina, Charleston
| | - Abbey Borich
- Medical University of South Carolina, Charleston
| | - Erin Seery
- Medical University of South Carolina, Charleston
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13
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Fernandez P, Azucar D, Zambole K. A Dose of Truth: A Qualitative Assessment of Reactions to Messages about Fentanyl for People Who Use Drugs. Subst Use Misuse 2023; 58:520-527. [PMID: 36762461 DOI: 10.1080/10826084.2023.2177112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Background: Fentanyl-related overdoses are occurring at alarming rates and developing campaigns to increase awareness about fentanyl and harm-reduction strategies is critical. A Dose of Truth is an educational campaign aiming to increase knowledge about the threat of fentanyl and risk of exposure among people who use drugs (PWUD). The current study tests preliminary concepts and messages for the campaign. Methods: Twenty-one one-on-one interviews were conducted with young adults ages 18-35 who use drugs. Participants discussed knowledge of fentanyl and perceived risk of exposure, and provided feedback on four concepts. Thematic analysis of transcripts generated insights about promising approaches and topics. Results: Findings demonstrated that fentanyl awareness is growing among PWUD, but they perceive low risk of exposure because they trust a source. Messaging that challenged that trust, by highlighting that contaminated drug supplies are increasingly widespread, made personal risk salient. Additionally, messaging conveyed through a personal narrative that encouraged carrying naloxone to protect friends was perceived as personally relevant. Conclusions: While opioid- and fentanyl-related campaigns exist, few have used an evidence-based process to guide campaign development. Addressing gaps in knowledge and developing messages that are personally relevant are foundational steps in creating effective campaigns on fentanyl and other substances.
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Affiliation(s)
| | | | - Kim Zambole
- Prevention First, Springfield, Illinois, USA
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14
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Marchand K, Turuba R, Katan C, Fogarty O, Fairbank J, Tallon C, Mathias S, Barbic S. "The system always undermined what I was trying to do as an individual": identifying opportunities to improve the delivery of opioid use services for youth from the perspective of service providers in four communities across British Columbia, Canada. Addict Sci Clin Pract 2023; 18:1. [PMID: 36593469 PMCID: PMC9806820 DOI: 10.1186/s13722-022-00359-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/21/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Substance use among youth is a longstanding global health concern that has dramatically risen in the era of highly toxic and unregulated drugs, including opioids. It is crucial to ensure that youth using unregulated opioids have access to evidence-based interventions, and yet, youth encounter critical gaps in the quality of such interventions. This study aims to address these gaps by identifying opportunities to improve the quality of opioid use services from the perspective of service providers, a perspective that has received scant attention. METHODS This community-based participatory study was conducted in four communities in British Columbia (Canada), a province that declared a public health overdose emergency in 2016. Human-centered co-design workshops were held to understand service providers' (n = 41) experiences, needs, and ideas for improving the quality of youth opioid use services/treatments in their community. Multi-site qualitative analysis was used to develop overarching experiences and needs themes that were further contextualized in each local community. A blended deductive and inductive thematic analysis was used to analyze the ideas data. RESULTS Three overarching themes were identified, reflecting service providers' goals to respond to youth in a timely and developmentally appropriate manner. However, this was significantly limited by organizational and systems-level barriers, revealing service providers' priorities for intra- and inter-organizational support and collaboration and systems-level innovation. Across communities, service providers identified 209 individual ideas to address these prioritized needs and improve the quality of youth opioid use services/treatments. CONCLUSION These themes demonstrate a multi-level tension between macro-level systems and the meso-level organization of youth opioid use services, which undermine the quality of individual-level care service providers can deliver. These findings underscore the need for a coordinated multi-level response, such as developing youth-specific standards (macro-level), increasing inter-organizational activities and collaboration (meso-level), and creating programs that are specific to youths' needs (micro-level).
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Affiliation(s)
- Kirsten Marchand
- Foundry, 915-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada. .,Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - Roxanne Turuba
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Christina Katan
- Canadian Centre on Substance Use and Addiction, 500-75 Albert St, Ottawa, ON K1P 5E7 Canada
| | - Oonagh Fogarty
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Jill Fairbank
- Canadian Centre on Substance Use and Addiction, 500-75 Albert St, Ottawa, ON K1P 5E7 Canada
| | | | - Steve Mathias
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Providence Health Care, 1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,Providence Research, 1190 Hornby St, Vancouver, BC V6Z 1Y6 Canada
| | - Skye Barbic
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.498725.5Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Providence Health Care, 1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,Providence Research, 1190 Hornby St, Vancouver, BC V6Z 1Y6 Canada
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15
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Wadden JJ, Hermiston J, Blydt-Hansen TD, Dhaliwal R, Gielen S, Virani A. Exploring the Ethical Considerations of Direct Contact in Pediatric Organ Transplantation: A Qualitative Study. AJOB Empir Bioeth 2022; 14:143-154. [PMID: 36574227 DOI: 10.1080/23294515.2022.2160513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Nonanonymized direct contact between organ recipients and donor families is a topic of international interest in the adult context. However, there is limited discussion about whether direct contact should be extended to pediatric settings due to clinician and researcher concerns of the potential harms to pediatric patients. METHODS We interviewed pediatric organ recipients, their families, and donorfamilies in British Columbia, Canada, to determine their views on direct contact. Interviews were conducted in two stages, with those who were further removed from the transplant process informing the approach to interviews with those who more recently went throughthe transplant process. RESULTS Twenty-nine individuals participated in twenty in-depth interviews. The study included participants from three major organ systems: kidney, heart, and liver. Only five participants expressed that direct contact might cause harm or discomfort, while twenty-three indicated they saw significant potential for benefits. Nearly half focused on the harms to others rather than themselves, and nearly two-thirds focused on the benefits for others rather than themselves. CONCLUSION There appears to be a community desire for direct contact in pediatric organ transplant programs among those living in British Columbia, Canada. These results suggest a need to revisit the medical community's assumptions around protection and paternalism in our practice as clinicians and researchers.
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Affiliation(s)
- Jordan Joseph Wadden
- Ethics Department, Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
- Department of Philosophy, University of British Columbia, Vancouver, BC, Canada
| | - Jordan Hermiston
- Family Services, BC Transplant, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics (Nephrology), University of British Columbia, Vancouver, BC, Canada
- Multi-Organ Transplant Program, BC Children's Hospital, Vancouver, BC, Canada
| | - Ranjeet Dhaliwal
- Patient and Family Partner, BC Transplant, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Shelby Gielen
- Patient and Family Partner, BC Transplant, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Alice Virani
- Ethics Services, Provincial Health Services Authority, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
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16
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Huang L. Practitioners’ perspectives on family-based intervention for illicit drug-using adolescents in Taiwan: a qualitative study. Subst Abuse Treat Prev Policy 2022; 17:30. [PMID: 35473714 PMCID: PMC9044611 DOI: 10.1186/s13011-022-00460-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/21/2022] Open
Abstract
Background Drug-related psychiatric comorbidity or death among adolescents has grown to become a public health threat in Taiwan. In an atmosphere of abstinence, few alternatives or rehabilitative options for troubled young people have caused many juveniles to be driven away from home and placed in closed institutions. The intersectionality of illegal substance use, deviant behaviours, and criminal offences among adjudicated adolescents is a challenge for the development of adolescent users’ harm reduction strategies. In addition, the relationships among the adolescents, their families, and practitioners might be undermined by coercive and mandatory court measures. As developing a harm reduction approach includes minimizing the negative effects on not only adolescents and also their families, this study aims to explore Taiwanese practitioners’ perspectives of family-based programmes for drug-using adolescents. Methods This study adopted a qualitative approach. Through face-to-face interviews and a focus group, accounts were collected from 28 key informants working in youth delinquency. The interviews were transcribed for analysis using qualitative analysis software, namely NVivo10. Results Practitioners tend to refer to an “adolescent-centred model” when describing their work with drug-using young people. From the frontline practitioners’ descriptions, the families of those youth needing treatment services are often vulnerable and disadvantaged. These families are seldom onboard because of low readiness and scarce resources. Although a legal framework is in place, resources, workforce, and programmes to engage and involve parents in the intervention are lacking. Despite the obstacles, practitioners have utilized a variety of strategies to obtain limited success, such as parent meetings, resources referrals, parent counselling, court support, voluntary parenting courses, illicit substance information sharing, and home visits. Practitioners also pointed out that therapeutic interventions are more effective than coercive or mandatory interventions for adolescents and also for their families. Conclusions Since most practitioners have an adolescent-centred work principle, their work with parents falls into professional-centred or family-allied work models. It is therefore suggested that resources be reallocated to involve parent counselling and intense treatment instead of mandatory parental education.
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Marchand K, Turuba R, Katan C, Brasset C, Fogarty O, Tallon C, Fairbank J, Mathias S, Barbic S. Becoming our young people’s case managers: caregivers’ experiences, needs, and ideas for improving opioid use treatments for young people using opioids. Subst Abuse Treat Prev Policy 2022; 17:34. [PMID: 35525987 PMCID: PMC9077957 DOI: 10.1186/s13011-022-00466-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Evidence continues to show that young people, ages 15-24, remain at significant risk of harms from non-medical opioid use and opioid use disorder (OUD), with experts calling for widespread implementation of developmentally-appropriate interventions. These recommendations include the involvement of caregivers in the prevention, early intervention, and treatment of young people using opioids. However, little research has investigated caregivers’ experiences supporting young people, leaving critical gaps in understanding this role. The aim of this study is to explore caregivers’ experiences accessing opioid use treatments with young people and their needs and ideas for improving such treatments. Methods This study reports qualitative findings from Phase 1 of the Improving Treatment Together project, a multi-phase, multi-site community-based participatory study broadly aimed at co-designing opioid use treatments to improve the experiences and outcomes of young people using non-medical opioids. During Phase 1, a total of 27 caregivers (parents, guardians) participated in full-day workshops that were conducted in three communities in British Columbia, Canada. Following human-centred co-design methods, caregivers engaged in small and large group discussions of their experiences, needs, and ideas for improving opioid use treatments for young people. Discussions were audio-recorded, transcribed verbatim, and thematically analysed. Results Across communities, caregivers’ main experiences were defined as ‘becoming our young people’s case managers’ and ‘enduring a never-ending rollercoaster’. To improve these experiences, two needs themes were identified – expanding organizational and system-level capacity and wider-spread understanding of opioid use as a health issue. Caregivers brainstormed a total of 378 individual ideas to meet these needs, several of which spanned multiple needs themes. Conclusions Caregivers’ experiences, needs, and ideas reveal critical opportunities for improving the quality of interventions for opioid use among young people. This study represents a substantial contribution to the design and implementation of developmentally-appropriate and family-centred interventions for young people using opioids.
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18
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Stowe MJ, Feher O, Vas B, Kayastha S, Greer A. The challenges, opportunities and strategies of engaging young people who use drugs in harm reduction: insights from young people with lived and living experience. Harm Reduct J 2022; 19:83. [PMID: 35883087 PMCID: PMC9327145 DOI: 10.1186/s12954-022-00663-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/07/2022] [Indexed: 11/24/2022] Open
Abstract
The meaningful inclusion of young people who use or have used drugs is a fundamental aspect of harm reduction, including in program design, research, service provision, and advocacy efforts. However, there are very few examples of meaningful and equitable engagement of young people who use drugs in harm reduction, globally. Youth continue to be excluded from harm reduction programming and policymaking; when they are included, they often face tokenistic efforts that lack clear expectations, equitable work conditions, and are rarely afforded agency and autonomy over decision-making. In this commentary, we identify and discuss issues in youth engagement, and offer recommendations for the future of harm reduction.
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Affiliation(s)
- M-J Stowe
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa. .,South African Network of People Who Use Drugs (SANPUD), Cape Town, Western Cape, South Africa.
| | | | - Beatrix Vas
- YouthRISE, Co Kerry, Ireland.,Unite-Global Parliamentarians Network to End Infectious Diseases, Lisbon, Portugal
| | | | - Alissa Greer
- School of Criminology, Simon Fraser University, Burnaby, BC, Canada
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19
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Marchand K, Fogarty O, Pellatt KM, Vig K, Melnychuk J, Katan C, Khan F, Turuba R, Kongnetiman L, Tallon C, Fairbank J, Mathias S, Barbic S. “We need to build a better bridge”: findings from a multi-site qualitative analysis of opportunities for improving opioid treatment services for youth. Harm Reduct J 2022; 19:37. [PMID: 35430803 PMCID: PMC9013476 DOI: 10.1186/s12954-022-00623-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Adolescence and young adulthood is an important period for substance use initiation and related harms. In the context of the ongoing opioid crisis, the risks for youth (ages 16–29) who use opioids are particularly heightened. Despite recommendations to adopt a developmentally appropriate and comprehensive approach to reduce opioid-related harms among youth, data continue to show that youth are not adequately engaged in opioid treatments and encounter many barriers. The aim of this study is to identify youth-centered opportunities for improving opioid treatment services.
Methods This paper reports multi-site qualitative findings from youth participating in the ‘Improving Treatment Together’ project, a community-based participatory project being conducted in British Columbia and Alberta, two western Canadian provinces that have been dramatically impacted by the opioid crisis. Qualitative data were collected during three workshops with youth who used opioids and accessed opioid treatment services in the prior 12 months. These workshops were conducted in three communities following the core elements of human-centered co-design. A multi-site qualitative analysis was conducted to identify within- and between-site themes surrounding youths’ needs for improving opioid treatment service experiences and outcomes. Results Three overarching needs themes were identified from across the communities. The first reflected youths’ difficulties finding and staying connected to opioid treatment services, with the overarching need theme suggesting opportunities to reduce organizational and systems-related barriers to care, such as waiting times and wider information about service availability. The second area of need was rooted in youths’ feelings of judgment when accessing services. Consequently, opportunities to increase respectful and empathic interactions were the overarching need. The final theme was more nuanced across communities and reflected opportunities for an individualized approach to opioid treatment services that consider youths’ unique basic safety, social, and health needs. Conclusions This study identifies fundamental directions for the operationalization and implementation of youth-centered opioid treatment services. These directions are contextualized in youths’ lived experiences accessing services in their local communities, with overarching themes from across sites strengthening their transferability to other settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00623-7.
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Krausz M, Westenberg JN, Tsang V, Suen J, Ignaszewski MJ, Mathew N, Azar P, Cabanis M, Elsner J, Vogel M, Spijkerman R, Orsolini L, Vo D, Moore E, Moe J, Strasser J, Köck P, Marian C, Dürsteler KM, Backmund M, Röhrig J, Post M, Haltmayer H, Wladika W, Trabi T, Muller C, Rechberger G, Teesson M, Farrell M, Christie G, Merry S, Mamdouh M, Alinsky R, Levy S, Fishman M, Rosenthal R, Jang K, Choi F. Towards an International Consensus on the Prevention, Treatment, and Management of High-Risk Substance Use and Overdose among Youth. Medicina (B Aires) 2022; 58:medicina58040539. [PMID: 35454376 PMCID: PMC9028633 DOI: 10.3390/medicina58040539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Objectives: Now more than ever, there is an obvious need to reduce the overall burden of disease and risk of premature mortality that are associated with mental health and substance use disorders among young people. However, the current state of research and evidence-based clinical care for high-risk substance use among youth is fragmented and scarce. The objective of the study is to establish consensus for the prevention, treatment, and management of high-risk substance use and overdose among youth (10 to 24 years old). Materials and Methods: A modified Delphi technique was used based on the combination of scientific evidence and clinical experience of a group of 31 experts representing 10 countries. A semi-structured questionnaire with five domains (clinical risks, target populations, intervention goals, intervention strategies, and settings/expertise) was shared with the panelists. Based on their responses, statements were developed, which were subsequently revised and finalized through three iterations of feedback. Results: Among the five major domains, 60 statements reached consensus. Importantly, experts agreed that screening in primary care and other clinical settings is recommended for all youth, and that the objectives of treating youth with high-risk substance use are to reduce harm and mortality while promoting resilience and healthy development. For all substance use disorders, evidence-based interventions should be available and should be used according to the needs and preferences of the patient. Involuntary admission was the only topic that did not reach consensus, mainly due to its ethical implications and resulting lack of comparable evidence. Conclusions: High-risk substance use and overdoses among youth have become a major challenge. The system’s response has been insufficient and needs substantial change. Internationally devised consensus statements provide a first step in system improvement and reform.
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Affiliation(s)
- Michael Krausz
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
| | - Jean N. Westenberg
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
- Center for Mental Health, Clinic for Addiction Medicine and Addictive Behavior, Klinikum Stuttgart, 70374 Stuttgart, Germany; (M.C.); (J.R.)
- Correspondence: ; Tel.: +1-604-827-4381
| | - Vivian Tsang
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
| | - Janet Suen
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
| | - Martha J. Ignaszewski
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
- BC Children’s Hospital, Vancouver, BC V6H 3N1, Canada;
| | - Nickie Mathew
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
- BC Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, BC V5Z 3L7, Canada
| | - Pouya Azar
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Maurice Cabanis
- Center for Mental Health, Clinic for Addiction Medicine and Addictive Behavior, Klinikum Stuttgart, 70374 Stuttgart, Germany; (M.C.); (J.R.)
| | - Julie Elsner
- Department of Psychiatry, Psychiatric University Clinics Basel, University of Basel, 4002 Basel, Switzerland; (J.E.); (M.V.); (J.S.); (P.K.); (C.M.); (K.M.D.)
| | - Marc Vogel
- Department of Psychiatry, Psychiatric University Clinics Basel, University of Basel, 4002 Basel, Switzerland; (J.E.); (M.V.); (J.S.); (P.K.); (C.M.); (K.M.D.)
- Psychiatric Services of Thurgovia, Division of Substance Use Disorders, 8596 Münsterlingen, Switzerland
| | - Renske Spijkerman
- Parnassia Addiction Research Centre (PARC), Brijder Addiction Treatment, Parnassia Group, 2512 The Hague, The Netherlands; (R.S.); (M.P.)
| | - Laura Orsolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, School of Medicine and Surgery, Polytechnic University of Marche, 60121 Ancona, Italy;
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Dzung Vo
- BC Children’s Hospital, Vancouver, BC V6H 3N1, Canada;
- Division of Adolescent Health and Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Eva Moore
- Division of Adolescent Health and Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Jessica Moe
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
- BC Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
| | - Johannes Strasser
- Department of Psychiatry, Psychiatric University Clinics Basel, University of Basel, 4002 Basel, Switzerland; (J.E.); (M.V.); (J.S.); (P.K.); (C.M.); (K.M.D.)
| | - Patrick Köck
- Department of Psychiatry, Psychiatric University Clinics Basel, University of Basel, 4002 Basel, Switzerland; (J.E.); (M.V.); (J.S.); (P.K.); (C.M.); (K.M.D.)
| | - Calin Marian
- Department of Psychiatry, Psychiatric University Clinics Basel, University of Basel, 4002 Basel, Switzerland; (J.E.); (M.V.); (J.S.); (P.K.); (C.M.); (K.M.D.)
| | - Kenneth M. Dürsteler
- Department of Psychiatry, Psychiatric University Clinics Basel, University of Basel, 4002 Basel, Switzerland; (J.E.); (M.V.); (J.S.); (P.K.); (C.M.); (K.M.D.)
| | - Markus Backmund
- Praxiszentrum im Tal, 80331 Munich, Germany;
- Ludwig-Maximilians-University, 80539 Munich, Germany
| | - Jeanette Röhrig
- Center for Mental Health, Clinic for Addiction Medicine and Addictive Behavior, Klinikum Stuttgart, 70374 Stuttgart, Germany; (M.C.); (J.R.)
| | - Marianne Post
- Parnassia Addiction Research Centre (PARC), Brijder Addiction Treatment, Parnassia Group, 2512 The Hague, The Netherlands; (R.S.); (M.P.)
| | | | - Wolfgang Wladika
- Department of Neurology and Psychiatry of Childhood and Adolescence, Klinikum Klagenfurt am Wörthersee, 9020 Klagenfurt, Austria;
| | - Thomas Trabi
- Department for Child and Adolescent Psychiatry and Pschotherapy, LKH Graz II, 8053 Graz, Austria;
| | - Christian Muller
- Department of Child & Youth Psychiatry and Psychotherapy, Psychosocial Service Burgenland GmbH, 7000 Eisenstadt, Austria;
| | - Gerhard Rechberger
- Verein Dialog, Integrative Suchtberatung Gudrunstraße, 1100 Wien, Austria;
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2031, Australia;
| | - Grant Christie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand; (G.C.); (S.M.)
| | - Sally Merry
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand; (G.C.); (S.M.)
| | - Mostafa Mamdouh
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
- Department of Neuropsychiatry, Tanta University, Tanta 31527, Egypt
| | - Rachel Alinsky
- Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Marc Fishman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21205, USA;
- Mountain Manor Treatment Center, Baltimore, MD 21229, USA
| | - Richard Rosenthal
- Department of Psychiatry and Behavioral Health, Stony Brook University, New York, NY 11794, USA;
| | - Kerry Jang
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
| | - Fiona Choi
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
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21
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Lloyd AR, Savage R, Eaton EF. Opioid use disorder: a neglected human immunodeficiency virus risk in American adolescents. AIDS 2021; 35:2237-2247. [PMID: 34387219 PMCID: PMC8563394 DOI: 10.1097/qad.0000000000003051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 2017 alone, 783 000 children aged 12-17 years misused opioids with 14 000 using heroin. Opioid misuse and opioid use disorder (OUD) in adolescents and young adults are significant barriers to ending the HIV epidemic. To address these synergistic scourges requires dedicated practitioners and improved access to life-saving evidence-based treatment. Adolescents and young adults make up over one in five new HIV diagnoses even though they are less likely to be tested or know they are infected. Adolescents and young adults living with HIV are less likely to be retained in care or achieve virological suppression. OUD further leads to increased rates of risky behaviours (like sex without condoms), deceased retention in HIV care and decreased rates of viral suppression in this vulnerable population. Medications for opioid use disorder (MOUD) are recommended for adolescents and young adults with severe OUD and help retain youth in HIV treatment and decrease risk of death. However, due to stigma and lack of experience prescribing MOUD in adolescents, MOUD is often perceived as a last line option. MOUD remains difficult to access for adolescents with a shortage of providers and decreased options for treatment as compared to adults. Addiction treatment is infection prevention, and integrated addiction and HIV services are recommended to improve health outcomes. A multipronged approach including patient education, provider training and policy changes to improve access to treatment and harm reduction are urgently needed confront the drug use epidemic in youth.
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Affiliation(s)
- Audrey R Lloyd
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham
| | - Rebekah Savage
- Division of Adolescent Medicine, University of Alabama at Birmingham
| | - Ellen F Eaton
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabamas, USA
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22
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Yonek JC, Velez S, Satre DD, Margolis K, Whittle A, Jain S, Tolou-Shams M. Addressing adolescent substance use in an urban pediatric federally qualified health center. J Subst Abuse Treat 2021; 135:108653. [PMID: 34840042 DOI: 10.1016/j.jsat.2021.108653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/24/2021] [Accepted: 10/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Screening, brief intervention, and referral to treatment (SBIRT) is a systematic approach to identification and intervention for individuals at risk for substance use disorders. Prior research indicates that SBIRT is underutilized in pediatric primary care. Yet few studies have examined procedures for identifying and addressing substance use in clinics that serve publicly insured adolescents (i.e., federally qualified health centers [FQHC]). This descriptive, multi-method study assessed adolescent substance use frequency and provider perspectives to inform SBIRT implementation in an urban pediatric FQHC in California. METHODS A medical record review assessed substance use frequency and correlates among publicly insured adolescents aged 12-17 years who completed a well-child visit in pediatric primary care between 2014 and 2017 (N = 2252). Data on substance use (i.e., alcohol, illicit drugs, and tobacco) were from a health assessment tool mandated by Medicaid. Semi-structured interviews with 12 providers (i.e., pediatricians, nurse practitioners, behavioral health clinicians) elicited information about the current clinic workflow for adolescent substance use and barriers and facilitators to SBIRT implementation. RESULTS Of 1588 adolescents who completed the assessment (70.5%), 6.8% reported current substance use. Self-reported use was highest among non-Hispanic Black (15.2%) adolescents and those with co-occurring depressive symptoms (14.4%). Provider-reported challenges to implementing SBIRT included a lack of space for confidential screening and a lack of referral options. Providers favored implementing technology-based tools such as tablets for adolescent pre-visit screening and electronic medical record-based decision support to facilitate brief intervention and treatment referrals. CONCLUSIONS This study fills a substantial research gap by examining factors that impede and support SBIRT implementation in pediatric FQHC settings. Successful SBIRT implementation in these settings could significantly reduce the unmet need for substance use treatment among uninsured and publicly insured adolescents. Pediatric primary care and urgent care providers perceived SBIRT to be feasible, and health information and digital technologies may facilitate the integration of SBIRT into clinic workflows. Ensuring confidentiality for screening and expanding referral options for adolescents in need of community-based addiction treatment are also critical to increasing SBIRT uptake.
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Affiliation(s)
- Juliet C Yonek
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Sarah Velez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States.
| | - Kathryn Margolis
- Department of Pediatrics at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 6B, San Francisco, CA 94110, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Amy Whittle
- Department of Pediatrics at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 6B, San Francisco, CA 94110, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Shonul Jain
- Department of Pediatrics at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 6B, San Francisco, CA 94110, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
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