Prevention of Opioid Use and Disorder Among Youth Involved in the Legal System: Innovation and Implementation of Four Studies Funded by the NIDA HEAL Initiative.

Youth involved in the legal system (YILS) experience rates of opioid and substance use disorders (OUD/SUDs) and overdose that is well above those in the general population. Despite the dire need, and the existing programs that focus on treatment of these problems in YILS, research on opioid initiation, and OUD prevention, including feasibility and sustainability, are severely limited. We present four studies testing interventions that, while not necessarily novel as SUD treatments, test novel structural and interpersonal strategies to prevent opioid initiation/OUD precursors: (1) ADAPT (Clinical Trial No. NCT04499079) provides real-time feedback using community-based treatment information system data to create a more effective mental health and SUD treatment cascade to prevent opioid use; (2) HOME (Clinical Trial No. NCT04135703) provides youth experiencing homelessness, including YILS, with direct access to shelter in independent living without prerequisites as an opioid initiation prevention strategy; (3) LeSA (Clinical Trial No. NCT04678960) uses the Trust-Based Relational Intervention® to equip YILS and their caregivers with self-regulatory and communication skills during the transition from secure confinement to reduce opioid initiation/re-initiation; and (4) POST (Clinical Trial No. NCT04901312) tests two interventions integrating interpersonal/drinking and drug refusal skills, case management, and goal setting among YILS in transitioning out of secure detention as opioid initiation prevention strategies. We discuss early implementation barriers and facilitators, including complexities of prevention research with YILS and adaptations due to COVID-19. We conclude by describing anticipated end products, including implementation of effective prevention interventions and integration of data from multiple projects to address larger, multi-site research questions.

Designing and piloting a sequential multiple assignment randomized trial for opioid prevention among youth in the legal system.

OBJECTIVE: Youth in the legal system are vulnerable to initiation and escalation of opioid use. The transition period during which a young person is released from the institutional setting to the community is a critical window of opportunity for preventive intervention targeting the uptake and intensification of opioid and other drug use. Adaptive preventive interventions are a promising approach to systematically varying the timing and intensity of substance use preventive interventions for these youth. METHOD: This pilot study of 30 youth (97% young men; 37% White; Mage = 18.34, SD = 1.84) examined the feasibility and acceptability of adaptive and nonadaptive preventive interventions that incorporate components of the Adolescent Community Reinforcement Approach with Assertive Continuing Care, Trauma Affect Regulation: Guide for Education and Treatment, and Motivational Interviewing using the Sequential Multiple Assignment Randomized Trial study design. Participants completed assessments at baseline, 1-month postrelease, and 2-months postrelease. RESULTS: Enrollment rate was 65%. Nearly three-quarters (73%) of enrolled youth had substance use disorder at intake. Moreover, 60% of enrolled participants completed the 2-month postrelease follow-up assessment. Participants reported high satisfaction with the interventionist interactions, and 95% indicated they would recommend the program to other youth. The pilot study revealed the need for several adaptations to study and intervention protocols. CONCLUSIONS: This pilot study provides evidence of the feasibility of a research-practice partnership with state juvenile rehabilitation facilities, successful recruitment of youth involved in the legal system, and feasibility and acceptability of adaptive preventive interventions spanning pre- and post-release for legal system-involved youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).