Orienting Patients to Greater Opioid Safety: Models of Community Pharmacy-Based Naloxone

The leading cause of adult injury death in the USA is drug overdose, the majority of which involves prescription opioid medications. Outside of the USA, deaths by drug overdose are also on the rise, and overdose is a leading cause of death for drug users. Reducing overdose risk while maintaining access to prescription opioids when medically indicated requires careful consideration of how opioids are prescribed and dispensed, how patients use them, how they interact with other medications, and how they are safely stored. Pharmacists, highly trained professionals expert at detecting and managing medication errors and drug-drug interactions, safe dispensing, and patient counseling, are an under-utilized asset in addressing overdose in the US and globally. Pharmacies provide a high-yield setting where patient and caregiver customers can access naloxone—an opioid antagonist that reverses opioid overdose—and overdose prevention counseling. This case study briefly describes and provides two US state-specific examples of innovative policy models of pharmacy-based naloxone, implemented to reduce overdose events and improve opioid safety: Collaborative Pharmacy Practice Agreements and Pharmacy Standing Orders

Changes in Exposure to Neighborhood Characteristics are Associated with Sexual Network Characteristics in a Cohort of Adults Relocating from Public Housing

Ecologic and cross-sectional multilevel analyses suggest that characteristics of the places where people live influence their vulnerability to HIV and other sexually-transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African-American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater post-relocation improvements in economic disadvantage, violent crime, and male:female sex ratios would experience greater reductions in perceived partner risk and in the odds of having a partner who had another partner (i.e., indirect concurrency). Baseline data were collected from 172 public housing residents before relocations occurred; three waves of post-relocation data were collected every nine months. Participants who experienced greater improvements in community violence and in economic conditions experienced greater reductions in partner risk. Reduced community violence was associated with reduced indirect concurrency. Structural interventions that decrease exposure to violence and economic disadvantage may reduce vulnerability to HIV/STIs

Sexual Minority, Justice-Involved Youth: A Hidden Population in Need of Integrated Mental Health, Substance Use, and Sexual Health Services

PurposeWe sought to compare the demographic characteristics, drug and alcohol use, sexual behaviors, delinquency, and mental health indicators of sexual minority and nonsexual minority first-time offending, court-involved, nonincarcerated adolescents.MethodsUsing adolescent- and caregiver-reported baseline data from the Epidemiologic Study Involving Children in the Court, a prospective cohort study of 423 adolescent-caregiver dyads recruited from a Northeastern family court system, we compared demographic and behavioral health characteristics of sexual minority and nonsexual minority first-time offending, court-involved, nonincarcerated adolescents.ResultsNearly one-third of the adolescents (31.4%, n = 133) were classified as a sexual minority; 19.6% (n = 81) self-identified with a nonheterosexual sexual orientation. Sexual minority adolescents were more likely than their nonsexual minority peers to identify as female, to have used psychiatric services or psychotropic medications, to have used an illicit drug or alcohol or to know peers who use these substances, to report alcohol/drug use during sex, to endorse more severe mental health problems, to have more recent post-traumatic symptoms, and to have engaged in self-harm behaviors. However, sexual minority adolescents did not differ from nonsexual minority adolescents in other demographic characteristics (including school performance) or delinquent behavior.ConclusionsOne-third of court-involved, nonincarcerated adolescents may be sexual minorities. Specificscreening methods are necessary to identify these adolescents and to address their unique risk characteristics, which include more severe mental health difficulties and higher rates of high-risk sexual behavior and drug/alcohol use compared with their nonsexual minority peers

“Good luck, social distance”: rapid decarceration and community care for serious mental illness and substance use disorder during the COVID-19 pandemic

The COVID-19 pandemic inspired calls for rapid decarceration of prisons and jails to slow the spread of disease in a high-risk congregate setting. Due to the rarity of intentionally-decarcerative policies, little is known about the effects of rapid decarceration on individuals with serious mental illness (SMI) substance use disorder (SUD), a population who receive many services via the criminal legal system (CLS). We conducted interviews with 13 key informants involved in CLS in San Francisco, CA to better understand the implication of the decarcerative policies put into practice in early 2020. Participants described a tension between the desire to have fewer people incarcerated and the challenges of accessing services and support - especially during the lockdown period of the pandemic - outside of the CLS given the number of services that are only accessible to those who have been arrested, incarcerated, or sentenced. These findings emphasize the need for investing in community social services rather than further expanding the CLS to achieve the goal of supporting individuals with SMI and SUD shrinking the US system of mass incarceration

Factors Associated With Use of Mental Health and Substance Use Treatment Services by Justice-Involved Youths

ObjectiveNonincarcerated (community-supervised) youths who are first-time offenders have high rates of mental and substance use disorders. However, little is known about their use of psychiatric services (mental health and substance use) or factors associated with service use. This study examined the prevalence, determinants, and barriers to service use among community-supervised youths.MethodsData were from a longitudinal study of mental health and substance use outcomes among adolescents ages 12-18 from a northeastern family court in which caregivers and youths completed assessments (N=423 dyads). The Behavior Assessment System for Children, Second Edition, assessed youths' psychiatric symptoms. The Child and Adolescent Services Assessment assessed service use and barriers. Family functioning and caregiver-adolescent communication were assessed with the McMaster Family Assessment Device and the Parent-Adolescent General Communication Scale, respectively. Multivariable regression analyses examined the cross-sectional relationship between youths' service use and determinants of use at baseline.ResultsOf the 423 youths, 49% experienced psychiatric symptoms and 36% used psychiatric services in the past 4 months. The highest adjusted odds of service use were associated with youths' psychiatric symptoms and caregivers' history of a psychiatric diagnosis. The lowest odds were associated with caregivers' identifying as being from racial and ethnic minority groups. Caregiver-reported barriers to service use differed according to prior service use and by caregiver race-ethnicity.ConclusionsResults suggest a need for interventions to increase access to and engagement in psychiatric services for community-supervised youths and the importance of caregiver factors in designing such interventions

Exploring adults as support persons for improved pre-exposure prophylaxis for HIV use among select adolescents and young adults in the Deep South.

PurposePre-exposure prophylaxis for HIV (PrEP) is an effective yet underutilized biomedical tool for adolescents and young adults' (AYA) HIV prevention due to barriers such as PrEP adherence. We assessed HIV prevention knowledge, attitudes and beliefs from adults who self-identified as a primary support person to an AYA.MethodsWe surveyed AYA primary support persons at an academic hospital. Univariate and multivariate regression analyses were completed to identify factors associated with the belief AYAs engaging in HIV-associated behaviors should use PrEP and willingness to support AYAs on PrEP.Results200 primary support persons completed the survey. Participants were predominately female (77%) and black (56%). Nearly all primary support persons believed AYAs engaging in HIV-associated behaviors should take PrEP (94%) and 98% would support an AYA taking PrEP via transportation to appointments, assistance with refilling prescriptions, medication reminders, or encouragement.ConclusionsPrimary support persons are willing to support AYAs using PrEP

Leveraging Technology to Increase Behavioral Health Services Access for Youth in the Juvenile Justice and Child Welfare Systems: a Cross-systems Collaboration Model

Behavioral health services access for justice- and child welfare-involved youth is limited despite significant need. Structural interventions to address limited access are nascent. Technology can advance access, but few interventions focus on system-impacted youth and their mental health needs and challenges. This article describes the development, process, and initial outcomes of the Youth Justice and Family Well-Being Technology Collaborative (JTC) that was formed to leverage technology within and across public health and justice-related systems to promote increased behavioral health services access. Cross-system considerations are identified for public health, court, and other key stakeholders to successfully integrate technology into practice to expand access to these critical services

Predictors of cannabis use among first-time justice-involved youth: A cohort study.

BackgroundJustice-involved youth use cannabis at higher rates than their same-aged peers increasing likelihood of adverse behavioral health consequences and continued legal involvement. This study examined individual level predictors of early onset use cannabis use (<13 years of age) and cannabis use initiation in the 12 months following first court contact.MethodsParticipants were 391 first-time justice-involved youth (56.9 % male; Mage = 14.6 years; 32.1 % White, 11.1 % Black, 14.7 % Other/Multi-racial, 42.2 % Latinx) and an involved caregiver (87.2 % female; Mage = 41.0 years). Baseline assessments captured individual level factors; cannabis use was assessed every four months post-baseline for 12 months. Primary analyses involved multivariable modified Poisson regressions and survival analysis.ResultsIn multivariable models, youth who reported lifetime cannabis use (n = 188, 48.1 %) were older, reported alcohol use and positive cannabis use expectancies. Greater self-control and self-concept were associated with lower likelihood of lifetime cannabis use. Youth who initiated cannabis during the 12-month follow-up (n = 30, 14.8 %) tended to be older, White/non-Latinx, and to report more psychiatric symptoms (posttraumatic stress, externalizing, internalizing, and affect dysregulation), delinquent behavior, lower levels of self-control, poorer self-concept, greater drug use intentions and positive cannabis expectancies. In the multivariable survival analysis, affect dysregulation, internalizing symptoms, and more positive cannabis expectancies remained independently and positively associated with cannabis initiation.ConclusionsThere is a critical and unique window of opportunity to prevent cannabis use initiation among first-time justice-involved youth. Research is needed to determine whether brief interventions that aim to modify expectancies about cannabis use reduce rates of cannabis initiation in this underserved population

History of sex exchange in women with a history of incarceration

Sex exchange among incarcerated women is not well-described in the literature. Sex exchange can lead to numerous adverse health outcomes, especially when combined with individual factors (e.g., depression and homelessness) and larger systemic inequalities. The purpose of this study was to explore factors associated with having a history of sex exchange among a sample of incarcerated women. Of 257 women surveyed in this study, 68 women (26.5%) reported a history of sex exchange. In multivariate logistic regression analysis, physical abuse history (p=.05, OR 2.20), history of two or more sexually transmitted infections (p=.01, OR 2.90), injection drug use (p=.04, OR 2.46) and crack-cocaine use (p\u3c.01, OR 3.42) were associated with prior sex exchange. This is one of only two studies to examine factors associated with prior sex exchange among incarcerated women. Our study has important implications for corrections providers to provide more comprehensive care, directly addressing the unique needs of this population