Identifying a Need for Mental Health Services Posthospitalization in Adolescent Trauma Patients

Background: Nearly 150,000 children were hospitalized due to an injury in 2018. Hospitalized patients are often prescribed opioids and as a result, one in eight adolescents will continue using opioids twelve months after hospitalization. Predictors of sustained opioid use and future misuse posthospitalization have yet to be studied in adolescents. One of these predictors may be mental health disorders following hospitalization. It is known mental health disorders can lead to substance use disorders if not addressed properly. In this study we examined the associations between injury severity, mental health, and substance use among adolescents. Methods: Patients between 12 to 18 years old admitted for trauma were surveyed upon enrollment, and subsequently at 1, 3, 6, and 12 months posthospitalization. These surveys measured anxiety, depression, posttraumatic stress, prescription and non-prescription drug use, pain severity and pain interference. Results: At enrollment and one-month posthospitalization, higher pain interference was associated with anxiety (p=.003), depression (p<.001), and PTSD (p=.004). Increased pain severity was also associated with higher PTSD (p=.003) However, at three months, pain severity and interference were only associated with PTSD (p=.005, p=.009). Frequent alcohol use and higher PTSD were found to be statistically significant at six and twelve months (p=.02). Regular prescription opioid use was related to higher anxiety (p=.048) and depression (p=.048) only at enrollment and higher PTSD only at one month (p=.034). Prescription opioid use was not associated with pain severity and interference at enrollment but was found significant at one month (p=.016, p=.36). Conclusion: Adolescents who reported higher pain severity and interference also more commonly had mental health disorders such as PTSD, anxiety, and depression. Higher PTSD scores and frequent alcohol use were also related post-injury. Screening for mental health after hospitalization should be further investigated in identifying adolescents who may be at risk for future opioid use disorders.

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Association Between Mental Health Disorders, Problem Drug Use, and Regular Prescription Opioid Use

Archives of Internal Medicine ◽

10.1001/archinte.166.19.2087 ◽

2006 ◽

Vol 166 (19) ◽

pp. 2087 ◽

Cited By ~ 238

Author(s):

Mark D. Sullivan ◽

Mark J. Edlund ◽

Lily Zhang ◽

Jürgen Unützer ◽

Kenneth B. Wells

Keyword(s):

Mental Health ◽

Drug Use ◽

Mental Health Disorders ◽

Prescription Opioid ◽

Opioid Use ◽

Health Disorders ◽

Problem Drug Use ◽

Prescription Opioid Use ◽

Problem Drug

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Prescription Opioid Use among Adults with Mental Health Disorders in the United States

The Journal of the American Board of Family Medicine ◽

10.3122/jabfm.2017.04.170112 ◽

2017 ◽

Vol 30 (4) ◽

pp. 407-417 ◽

Cited By ~ 86

Author(s):

Matthew A. Davis ◽

Lewei A. Lin ◽

Haiyin Liu ◽

Brian D. Sites

Keyword(s):

Mental Health ◽

United States ◽

The United States ◽

Mental Health Disorders ◽

Prescription Opioid ◽

Opioid Use ◽

Health Disorders ◽

Prescription Opioid Use

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Chronic High Risk Prescription Opioid Use Among Persons With HIV

Frontiers in Sociology ◽

10.3389/fsoc.2021.645992 ◽

2021 ◽

Vol 6 ◽

Author(s):

Ana Ventuneac ◽

Gavriella Hecht ◽

Emily Forcht ◽

Bianca A. Duah ◽

Shafaq Tarar ◽

...

Keyword(s):

Mental Health ◽

Substance Use ◽

High Risk ◽

Substance Use Disorders ◽

Prescribing Patterns ◽

Hiv Care ◽

Prescription Opioid ◽

Opioid Use ◽

Opioid Prescribing ◽

Prescription Opioid Use

Persons with HIV (PWH) are a population at risk for adverse sequelae of opioid use. Yet, few studies have examined correlates of chronic high risk opioid use and its impact on HIV outcomes. Trends in prescribing patterns and identification of factors that impact the use of opioid prescriptions among PWH are crucial to determine prevention and treatment interventions. This study examined electronic medical records (EMR) of patients receiving HIV care to characterize prescribing patterns and identify risk factors for chronic high risk prescription opioid use and the impact on HIV outcomes among PWH in primary care from July 1, 2016–December 31, 2017. EMR were analyzed from 8,882 patients who were predominantly male and ethnically and racially diverse with half being 50 years of age or older. The majority of the 8,744 prescriptions (98% oral and 2% transdermal preparations) given to 1,040 (12%) patients were oxycodone (71%), 8% were morphine, 7% tramadol, 4% hydrocodone, 4% codeine, 2% fentanyl, and 4% were other opioids. The number of monthly prescriptions decreased about 14% during the study period. Bivariate analyses indicated that most demographic and clinical variables were associated with receipt of any opioid prescription. After controlling for patient socio-demographic characteristics and clinical factors, the odds of receipt of any prescription were higher among patients with pain diagnoses and opioid use and mental health disorders. In addition, the odds of receipt of high average daily morphine equivalent dose (MED) prescriptions were higher for patients with pain diagnoses. Lastly, patients with substance use disorders (SUD) had an increased likelihood of detectable viral load compared to patients with no SUD, after adjusting for known covariates. Our findings show that despite opioid prescribing guidelines and monitoring systems, additional efforts are needed to prevent chronic high risk prescriptions in patients with comorbid conditions, including pain-related, mental health and substance use disorders. Evidence about the risk for chronic high risk use based on prescribing patterns could better inform pain management and opioid prescribing practices for patients receiving HIV care.

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Receipt of medications for opioid use disorder among youth engaged in primary care: data from 6 health systems

Addiction Science & Clinical Practice ◽

10.1186/s13722-021-00249-3 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Sarah M. Bagley ◽

Laura Chavez ◽

Jordan M. Braciszewski ◽

Mary Akolsile ◽

Denise M. Boudreau ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Substance Use ◽

Health Systems ◽

Substance Use Disorders ◽

Mental Health Disorders ◽

Opioid Use Disorder ◽

Opioid Use ◽

Medication Treatment ◽

Health Disorders

Abstract Purpose Little is known about prevalence and treatment of OUD among youth engaged in primary care (PC). Medications are the recommended treatment of opioid use disorder (OUD) for adolescents and young adults (youth). This study describes the prevalence of OUD, the prevalence of medication treatment for OUD, and patient characteristics associated with OUD treatment among youth engaged in PC. Methods This cross-sectional study includes youth aged 16–25 years engaged in PC. Eligible patients had ≥ 1 PC visit during fiscal years (FY) 2014–2016 in one of 6 health systems across 6 states. Data from electronic health records and insurance claims were used to identify OUD diagnoses, office-based OUD medication treatment, and patient demographic and clinical characteristics in the FY of the first PC visit during the study period. Descriptive analyses were conducted in all youth, and stratified by age (16–17, 18–21, 22–25 years). Results Among 303,262 eligible youth, 2131 (0.7%) had a documented OUD diagnosis. The prevalence of OUD increased by ascending age groups. About half of youth with OUD had documented depression or anxiety and one third had co-occurring substance use disorders. Receipt of medication for OUD was lowest among youth 16–17 years old (14%) and highest among those aged 22–25 (39%). Conclusions In this study of youth engaged in 6 health systems across 6 states, there was low receipt of medication treatment, and high prevalence of other substance use disorders and mental health disorders. These findings indicate an urgent need to increase medication treatment for OUD and to integrate treatment for other substance use and mental health disorders.

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Prevalence of Mental Health Disorders among Individuals Enrolled in an Emergency Response Program for Treatment of Opioid Use Disorder

Substance Abuse Research and Treatment ◽

10.1177/1178221820981998 ◽

2020 ◽

Vol 14 ◽

pp. 117822182098199

Author(s):

Christine Bakos-Block ◽

James R Langabeer ◽

Andrea Yatsco ◽

Marylou Cardenas-Turanzas ◽

Tiffany Champagne-Langabeer

Keyword(s):

Mental Health ◽

Substance Use ◽

Anxiety Disorders ◽

Emergency Response ◽

Mental Health Disorders ◽

Opioid Use Disorder ◽

Emergency Setting ◽

Opioid Use ◽

Mood And Anxiety Disorders ◽

Health Disorders

Background: Psychiatric co-occurring disorders among individuals with opioid use disorder has primarily focused on epidemiological surveys of patients in continuous or long-term treatment, yet little is known about the socio-economically vulnerable who are non-treatment seeking prior to an emergency response. Methods: We retrospectively analyzed data from patients who had enrolled in a study involving home outreach to patients referred from police, emergency medical services (EMS), or hospital emergency departments following an emergency response. The sample is largely socio-economically vulnerable with high rates of unemployment and uninsured. Eligible consenting patients received an intervention consisting of medication (buprenorphine), behavioral counseling, and peer support. Participants completed semi-structured, psychological instruments to assess current and prior history for both substance use and mental health disorders. We used descriptive statistics to evaluate rates of co-occurring mental health comorbidity. Results: Among 102 patients (average age = 36.5 years old), approximately 61 (59.8%) reported a prior mental health diagnosis, with 31 (30.3%) currently on medications for their diagnoses. Mood and anxiety disorders were most frequently recorded. Just over half (51%) had received any prior treatment for their substance use. Of those with dual disorders, 67.2% had experienced prior suicidal thoughts, and 63.7% reported polysubstance use of 5 or more substances. Conclusion: Co-occurring psychiatric disorders, and specifically mood and anxiety disorders, appear to be prevalent in vulnerable populations at an increased rate. Mental health assessments should routinely be performed in the emergency setting and in early stages of treatment.

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Systematic Review of Criminal and Legal Involvement After Substance Use and Mental Health Treatment Among Veterans: Building Toward Needed Research

Substance Abuse Research and Treatment ◽

10.1177/1178221819901281 ◽

2020 ◽

Vol 14 ◽

pp. 117822181990128

Author(s):

Christine Timko ◽

Amia Nash ◽

Mandy D Owens ◽

Emmeline Taylor ◽

Andrea K Finlay

Keyword(s):

Mental Health ◽

Systematic Review ◽

Substance Use ◽

Mental Health Treatment ◽

Criminal Activity ◽

Mental Health Disorders ◽

Opioid Use ◽

Health Treatment ◽

Health Disorders ◽

Effective Treatments

Evidence indicates that substance use and mental health treatment is often associated with reduced criminal activity. The present systematic review examined this association among military veterans, and aimed to provide a comprehensive summary of needed research to further contribute to reduced criminal activity among veterans. This systematic review was derived from a scoping review that mapped existing research on justice-involved veterans’ health. For the current systematic review, a subset of 20 publications was selected that addressed the question of whether criminal activity declines among veterans treated for substance use and mental health disorders. Generally, veterans improved on criminal outcomes from pre- to post-treatment for opioid use, other substance use, or mental health conditions, and more sustained treatment was associated with better outcomes. This occurred despite high rates of criminal involvement among veterans prior to entering treatment. Needed are substance use and mental health treatment studies that include women justice-involved veterans, follow criminally-active veterans for longer periods of time, and use validated and reliable measures of criminal activity with fully transparent statistical procedures. Future randomized trials should evaluate new treatments against evidence-based treatments (versus no-treatment control conditions). Subsequent studies should examine how to link veterans to effective treatments, facilitate sustained treatment engagement, and ensure the availability of effective treatments, and examine mechanisms (mediators and moderators) that explain the association of treatment with reduced criminal activity among veterans. Best practices are needed for reducing criminal activity among the minority of justice-involved veterans who do not have diagnosed substance use and/or mental health disorders.

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