Strategies to Improve Access to Care for Patients With Opioid Use Disorder.

Treatment of opioid use disorder (OUD) faces several challenges, including restricted access to medications, geographical and logistical barriers, and variability in treatment availability across different communities. This article outlines several strategies aimed at improving access to medications. Pharmacy-based care could potentially extend access to medications but would require regulatory changes to empower pharmacists. In addition, telemedicine has shown promise in improving access by mitigating geographic and transportation barriers. Mobile health clinics also offer a direct approach to delivering medication-based treatments to underserved communities. Furthermore, integrating OUD treatment into primary care settings could facilitate early detection and treatment. Policy changes have increased access to take-home medications and buprenorphine initiation at home. Community engagement would be crucial for tackling the social determinants of health to offer equitable care for patients. The implementation of these strategies has the potential to significantly enhance the accessibility and delivery of effective, timely and equitable treatment to patients with OUD.

Body Mass Index Changes Among Adolescents and Young Adults Using the Etonogestrel Contraceptive Implant.

OBJECTIVE: To evaluate body mass index (BMI) over 36 months among adolescents and young adults using the etonogestrel implant compared with those using depot medroxyprogesterone acetate (DMPA) and a control group. METHODS: We conducted a retrospective longitudinal cohort study of postmenarchal adolescents and young adults assigned female at birth. The etonogestrel implant and DMPA groups initiated etonogestrel or DMPA between January 1, 2010, and December 31, 2017. Adolescents and young adults in the control group were prescribed a weight-neutral contraceptive or no contraceptive during the same timeframe. The primary outcome of BMI over time was estimated and compared between study groups with inverse probability of treatment weighting linear mixed-effects modeling. Changes in BMI weight category (underweight or normal weight, overweight, obesity) at 12, 24, and 36 months were also explored. RESULTS: Among the 20,409 eligible patients, 860 initiated etonogestrel, 1,817 initiated DMPA, and 17,732 made up the control group. Compared with individuals in the control group, those in the etonogestrel group had a significantly higher mean BMI difference at 9 months (+0.5, P<.01); at 36 months, the mean BMI difference was +1.0 (P<.01). Compared with individuals in the control group, those in the DMPA group had higher mean BMI at 6 months (+0.3, P<.01); at 36 months, the mean BMI difference was +1.3 (P<.01). Regardless of weight changes, increases in BMI weight categories were rare in all groups. CONCLUSION: Adolescent and young adult patients who initiated the etonogestrel implant demonstrated BMI changes like those on DMPA and higher than control patients; however, these differences may not be clinically concerning. This study provides important information that can help in counseling adolescent and young adult patients about expectations when starting and using etonogestrel.

Fertility Perspectives and Concerns in Adolescents With PCOS Compared to Controls.

PURPOSE: Polycystic ovary syndrome (PCOS) is prevalent in young females and is known to affect fertility. Minimal research has examined fertility perspectives in adolescents with PCOS, despite adult research revealing relationships between infertility and psychosocial well-being and quality of life. We examined fertility perspectives/concerns in adolescents with PCOS and an age- and body mass index (BMI)-matched control group and explored associations with quality of life. METHODS: This was a cross-sectional study of female adolescents (13-21 years of age) with PCOS (n = 50) and age- and BMI-matched controls (n = 50), recruited at a large Midwestern pediatric center. Surveys assessed sociodemographics, hirsutism, fertility perspectives and quality of life. Descriptive statistics and Welch's 2-sample t-tests were used to examine fertility perspectives and quality of life. RESULTS: Of the 103 approached, 100 participants were enrolled (97% recruitment rate), with 50 participants in each group. Parenthood goals did not significantly differ between groups; >70% expressed desire to have biological children. However, PCOS participants reported significantly higher concerns about future fertility (p < .01) without differences in fertility knowledge or support (p = .53). Most PCOS participants stated they would feel angry if their provider withheld this information and reported wanting more information. Quality of life did not differ between groups. DISCUSSION: Our study suggests that irrespective of PCOS status, most adolescents aspire to parenthood. Notably, many with PCOS lack awareness of infertility risks but express heightened concerns. In contrast to adult studies, fertility concerns among adolescents with PCOS were not associated with decreased quality of life, suggesting that earlier fertility counseling may improve outcomes.

An Exploration of Contraceptive Choice Pathways in Adolescents and Young Adults.

PURPOSE: To visualize contraceptive choice pathways among adolescent and young adults (AYA) designated female at birth (DFAB) as a means of exploring the relationships between current contraceptive use, desired contraceptive, and ultimately, chosen contraceptive method. METHODS: A retrospective cross-sectional study was conducted of AYA DFAB (N = 2369), aged 14-24 years, presenting for initial visit at a contraceptive clinic with standardized efficacy-based counseling. Sankey diagrams were utilized to visualize patient flow through the contraceptive decision-making process. Outcomes of interest were current contraceptive method, desired contraceptive prior to contraceptive counseling, and then chosen contraception. Chi-Square tests were conducted to quantify the strength of the relationships identified by the Sankey diagrams. RESULTS: Sankey diagrams demonstrated a fair amount of change from current contraceptive to desired contraceptive and from current contraceptive to chosen contraceptive. A stronger relationship was evident between desired contraceptive method and chosen method; most patients did not change their desired contraceptive after receiving counseling except AYA who were undecided about their desired contraceptive who flowed variably into all available methods. Chi-Square test assessing the association between desired and chosen contraceptive method was significant at P-value < .001, validating the patterns identified with the Sankey diagrams. DISCUSSION: We identified distinct contraceptive decision-making pathways among AYA which could inform the framework for a more tailored counseling approach. These findings are aligned with national medical organizations' recommendations for provision of non-coercive, patient-centered contraceptive counseling to promote adolescent reproductive autonomy.

Comprehensive transition of care for polycystic ovary syndrome from adolescence to adulthood.

Polycystic ovary syndrome (PCOS) is a lifelong chronic condition that affects one in ten females and can be diagnosed in adolescence. As adolescents with PCOS transition to adulthood, counselling for lifestyle management and mental health concerns often transition from involving the family unit to increasingly individual-focused approaches. PCOS is associated with a large range of comorbidities affecting reproductive, metabolic, dermatological, and psychological health. The diagnosis and comorbidities of PCOS are influenced by pubertal hormones and need to be reassessed continuously to ensure that treatment remains appropriate for age and development. As young patients grow up, personal concerns often change, especially in relation to reproductive management. In this Review, we present prevalence rates, screening tools, and treatment recommendations for PCOS-related conditions, and we consider the diagnostic and clinical elements of optimal transition of care models that ensure continuity of comprehensive care for adolescents moving from the paediatric health-care system to the adult health-care system.

Mobile Application Measurement of Menstrual Cycle Characteristics and Their Association with Dysmenorrhea and Activity Limitation in Early Adolescents.

OBJECTIVE: Real-time tracking of menstrual bleeding is a barrier to research due to limitations with traditional data collection tools. This prospective cohort study utilized a mobile application (TDot app) in young adolescents aged 10-14 years to assess the relationship between heavy menstrual bleeding (HMB), dysmenorrhea, and activity limitation. METHODS: Menstrual cycles were captured over six months in real-time using the Pictorial Blood loss Assessment Chart (PBAC). A median PBAC score of >100 was used to identify participants with HMB. Participants also completed a modified WaLIDD (Working ability, Location, Intensity, Days of pain, Dysmenorrhea) scale. Impact of menses on daily activities was collected for each cycle. RESULTS: A total of 160 participants enrolled and 100 (63%) participants with ≥3 cycles recorded in the mobile app were analyzed. HMB was noted in 41% of participants. Median modified WaLIDD score was significantly higher in participants with HMB than those without HMB (p=0.01). No significant differences were found in activity limitations between participants with and without HMB (p=0.34). Median modified WaLIDD score for participants with activity limitation was significantly higher than those without activity limitation (p=0.01). CONCLUSION: Utilizing mobile app technology, we were able to gather real-time menstrual outcome data from young adolescents on heaviness of flow, dysmenorrhea and activity limitations. While we did not find that patients with HMB were more likely to have activity limitations, we did find that those with limitations had modestly higher dysmenorrhea scores. Future studies should focus on identifying additional variables that impact activity limitation during menstruation.

Adrenal Crisis Masked as Septic Shock in a Patient With Opioid Use Disorder on Buprenorphine.

Opioid-induced adrenal insufficiency is a known side effect of chronic opioid use, but opioid-induced adrenal insufficiency related to chronic buprenorphine-naloxone therapy is less well-known. We present a case of a patient with opioid use disorder on chronic buprenorphine-naloxone therapy admitted with presumed septic shock and found to be in an adrenal crisis. The patient presented to our hospital with a shock-like presentation, requiring vasopressors, intubation, empiric glucocorticoids, and antibiotics. As her steroids were weaned, she developed bradycardia and blood glucose in the 60s. A low- and high-dose cosyntropin stimulation test confirmed the presence of secondary adrenal insufficiency, presumed to be due to her chronic buprenorphine-naloxone use. She was discharged on maintenance hydrocortisone and continued buprenorphine-naloxone therapy. With the high prevalence of opioid use disorder and the common need for medication for opioid use disorder, it is important that healthcare providers properly identify opioid-induced adrenal insufficiency in order to quickly and correctly diagnose and treat adrenal crises.

Patterns and perceptions of nicotine use among U.S. adolescents and young adults receiving medication treatment for opioid use disorder.

Nicotine use among U.S. youth is cause for concern, as previous studies have shown that nicotine use in adolescence increases the risk of developing substance use disorders later in life. This exploratory study aimed to understand patterns of nicotine use and perceptions of various nicotine products among adolescents and young adults (AYA) receiving medication treatment for opioid use disorder (MOUD). We administered an adapted version of the National Youth Tobacco Survey via REDCap to AYA (n = 32) receiving outpatient care in the Medication-Assisted Treatment of Addiction at Nationwide Children's Hospital in Columbus, Ohio, U.S.A. Thirty (97%) participants had tried a combustible cigarette and 27 (90%) had tried an electronic cigarette. By age 13, nineteen (61%) participants had tried combustible cigarettes and eight (25%) had tried opioids. Twenty-two (71%) participants reported smoking combustible cigarettes every day for the past 30 days, and 15 (48%) reported smoking more than 10 cigarettes per day on average. Only ten (32%) participants reported e-cigarette use in the last 30 days. Participants universally agreed that tobacco products are dangerous, and twenty (67%) current tobacco users reported that they planned to quit in the next year. Nicotine use patterns among AYA receiving MOUD differ from that previously shown in the general population, primarily by high prevalence of nicotine use in early adolescence and high current combustible cigarette use. Interventions such as universal screening for nicotine use before age 13 and tailored smoking cessation programs for AYA with OUD may help optimize care for these individuals.

Trauma and Resilience in Adolescents and Young Adults With Opioid Use and Eating Disorders.

Substance use disorders and feeding and eating disorders (FEDs) often manifest in early adolescence, are difficult to treat, and tend to co-occur. Despite their co-occurrence, little is known about their shared risk factors. A cross-sectional study was conducted to compare standardized measures of adverse childhood experiences (ACEs) and protective factors among 90 adolescents and young adults seeking outpatient treatment for either opioid use disorder (OUD) or an FED. These were assessed using the Modified Adverse Childhood Experience Survey and Southern Kennebec Healthy Start Resilience Survey. Reported ACEs were high in both groups compared with the national average, and those with OUD were more likely to endorse ≥4 resilience factors. Meanwhile, the prevalence of emotional neglect, household mental illness, and peer victimization/isolation/rejection was similar between groups. Opioid use disorder patients were also less likely to endorse ≥9 resilience factors. Health providers should be mindful to assess for trauma and resiliency in both these populations.

A Pilot Study of Adolescent and Young Adult Experience with Subcutaneous Depot Medroxyprogesterone Acetate.

STUDY OBJECTIVE: To describe satisfaction with and preference for subcutaneous depot medroxyprogesterone acetate (DMPA-SC), along with adherence and feasibility, in adolescents and young adults (AYAs) METHODS: Survey of a sample of AYA patients who received DMPA-SC prescription and injection RESULTS: Of 108 eligible patients, 34 completed the survey, and 29 respondents received at least 1 DMPA-SC injection. The mean age was 16.9 years. Seventy-nine point three percent used it for gynecologic reasons, 27.6% for gender dysphoria, and 20.7% for contraception (multiple responses allowed); 93.1% were satisfied with DMPA-SC; 78.6% gave DMPA-SC on time; 88.9% reported that giving the injection was easy; 89.7% reported no problems with administration; 89.3% reported no problems obtaining DMPA-SC; and 76.9% plan to continue using DMPA-SC. CONCLUSION: In this small sample of patients within a children's hospital, the overall experience with DMPA-SC was favorable. Clinicians caring for adolescents should consider including DMPA-SC in counseling when depot medroxyprogesterone acetate (DMPA) is indicated.

An integrated abundance model for estimating county-level prevalence of opioid misuse in Ohio.

Opioid misuse is a national epidemic and a significant drug related threat to the United States. While the scale of the problem is undeniable, estimates of the local prevalence of opioid misuse are lacking, despite their importance to policy-making and resource allocation. This is due, in part, to the challenge of directly measuring opioid misuse at a local level. In this paper, we develop a Bayesian hierarchical spatio-temporal abundance model that integrates indirect county-level data on opioid-related outcomes with state-level survey estimates on prevalence of opioid misuse to estimate the latent county-level prevalence and counts of people who misuse opioids. A simulation study shows that our integrated model accurately recovers the latent counts and prevalence. We apply our model to county-level surveillance data on opioid overdose deaths and treatment admissions from the state of Ohio. Our proposed framework can be applied to other applications of small area estimation for hard to reach populations, which is a common occurrence with many health conditions such as those related to illicit behaviors.

A Descriptive Study on Opioid Misuse Prevalence and Office-Based Buprenorphine Access in Ohio Prior to the Removal of the Drug Addiction Treatment Act of 2000 Waiver.

Background Medications for the treatment of opioid use disorder (MOUD) are effective evidence-based strategies to reduce opioid overdose deaths. Strategies to optimize MOUD availability and uptake are needed. Objective We aim to describe the spatial relationship between the estimated prevalence of opioid misuse and office-based buprenorphine access in the state of Ohio prior to the removal of the Drug Addiction Treatment Act of 2000 (DATA 2000) waiver requirement. Methods We conducted a descriptive ecological study of county-level (N=88) opioid misuse prevalence and office-based buprenorphine prescribing access in Ohio in 2018. Counties were categorized into urban (with and without a major metropolitan area) and rural. The county-level prevalence estimates of opioid misuse per 100,000 were derived from integrated abundance modeling. Utilizing data from the Ohio Department of Mental Health and Addiction Services, as well as the state's Physician Drug Monitoring Program (PDMP), buprenorphine access per 100,000 was estimated by the number of patients in each county that could be served by office-based buprenorphine (prescribing capacity) and the number of patients served by office-based buprenorphine (prescribing frequency) for opioid use disorder. The ratios of opioid misuse prevalence to both prescribing capacity and frequency were calculated by county and mapped. Results Less than half of the 1,828 waivered providers in the state of Ohio in 2018 were prescribing buprenorphine, and 25% of counties had no buprenorphine access. The median estimated opioid misuse prevalence and buprenorphine prescribing capacity per 100,000 were highest in urban counties, particularly those with a major metropolitan area. Although the median estimated opioid misuse prevalence was lower in rural counties, all counties in the highest quartile of estimated misuse prevalence were rural. In addition, the median buprenorphine prescribing frequency was highest in rural counties. While the ratio of opioid misuse prevalence to buprenorphine prescribing capacity was lowest in urban counties, the ratio of opioid misuse prevalence to buprenorphine prescribing frequency was lowest in rural counties. Opioid misuse prevalence and buprenorphine prescribing frequency demonstrated similar spatial patterns, with highest levels in the southern and eastern portions of the state, while office-based buprenorphine prescribing capacity did not. Conclusion Urban counties had higher buprenorphine capacity relative to their burden of opioid misuse; however, access was limited by buprenorphine prescribing frequency. In contrast, in rural counties, a minimal gap was evident between prescribing capacity and frequency, suggesting that buprenorphine prescribing capacity was the major factor limiting access. While the recent deregulation of buprenorphine prescribing should help improve buprenorphine access, future research should investigate whether deregulation similarly impacts buprenorphine prescribing capacity and buprenorphine prescribing frequency.

A Dynamic Spatial Factor Model to Describe the Opioid Syndemic in Ohio.

BACKGROUND: The opioid epidemic has been ongoing for over 20 years in the United States. As opioid misuse has shifted increasingly toward injection of illicitly produced opioids, it has been associated with HIV and hepatitis C transmission. These epidemics interact to form the opioid syndemic. METHODS: We obtain annual county-level counts of opioid overdose deaths, treatment admissions for opioid misuse, and newly diagnosed cases of acute and chronic hepatitis C and newly diagnosed HIV from 2014 to 2019. Aligned with the conceptual framework of syndemics, we develop a dynamic spatial factor model to describe the opioid syndemic for counties in Ohio and estimate the complex synergies between each of the epidemics. RESULTS: We estimate three latent factors characterizing variation of the syndemic across space and time. The first factor reflects overall burden and is greatest in southern Ohio. The second factor describes harms and is greatest in urban counties. The third factor highlights counties with higher than expected hepatitis C rates and lower than expected HIV rates, which suggests elevated localized risk for future HIV outbreaks. CONCLUSIONS: Through the estimation of dynamic spatial factors, we are able to estimate the complex dependencies and characterize the synergy across outcomes that underlie the syndemic. The latent factors summarize shared variation across multiple spatial time series and provide new insights into the relationships between the epidemics within the syndemic. Our framework provides a coherent approach for synthesizing complex interactions and estimating underlying sources of variation that can be applied to other syndemics.

Retention in Office-Based Opioid Treatment and Impact on Emergency Department Use in Adolescents and Young Adults With Opioid Use Disorder.

PURPOSE: Longer retention in medication treatment (MT) of addiction is associated with improved health outcomes among adults with opioid use disorder. MT remains underutilized among adolescents and young adults (AYA); factors associated with MT retention are not well-defined and effect of retention on treatment outcomes is unknown. This study examined patient characteristics associated with retention in an office-based opioid treatment program for AYA patients and determined the impact of retention time on emergency department (ED) utilization. METHODS: This was a retrospective study of AYA patients from January 1, 2009, to December 31, 2020. Retention time was the difference between first and last appointment, analyzing follow-up periods of one and two years. Linear regression assessed factors associated with retention. Negative binomial regression showed effect of retention on ED utilization. RESULTS: A total of 407 patients were included. Factors positively associated with retention were diagnosis of anxiety, depression, and nicotine use disorder, White race, private insurance, and Medicaid insurance; however, stimulant/cocaine use disorder was negatively associated (one-year follow-up, p ≤ .028; two-year follow-up, p ≤ .017). Longer retention was associated with reduced risk of ED utilization at one-year (incident rate ratio = 0.84, 95% confidence interval: 0.72-0.99; p = .03) and two-year follow-ups (incident rate ratio = 0.86 95% confidence interval: 0.77-0.96; p = .008). DISCUSSION: Diagnosis of anxiety, depression, nicotine use disorder, and stimulant/cocaine use disorder, and insurance and race can influence retention in MT. Longer retention in MT was associated with lower ED visits, decreasing health care utilization. MT programs should evaluate various interventions to optimize opportunities for increasing retention among their patient cohorts.

Implementing Evidence-Based, Electronic, Substance-Use Screening in a Primary Care Clinic.

PURPOSE: Substance use is common among adolescents, and among those with substance use disorders; use often persists into middle age, underlying the importance of early detection and treatment. The goal of this quality improvement project was to increase the electronic substance use screening rate of adolescents presenting for preventative health visits from 0% to 50% between March 2021 and September 2021. METHODS: This is an ongoing quality improvement project. Participants included patients ≥12 who presented to the Adolescent Medicine Clinic for preventative health visits. We incorporated the Screening to Brief Intervention into the existing Car, Relax, Alone, Forget, Friends, Trouble tool within the electronic health record. We completed a Plan-Do-Study-Act cycle by reviewing every patient's chart who did not receive screening and identified that a common reason for missed screening was designating the visit as "establishing care" rather than preventative health visit. We modified our eligible patient criteria to include all adolescents presenting to establish primary care. RESULTS: We achieved a statistically significant center-line shift with a p value (<.001) from approximately 0% at baseline to a new baseline of 85% from June 2021 to June 2022. After broadening our eligibility criteria, our electronic screening rate improved from 78% in November 2021, to 83% in December 2021. DISCUSSION: Electronic health record integration of the Screening to Brief Intervention/Car, Relax, Alone, Forget, Friends, Trouble is an effective method to systematically and electronically screen adolescents for SUD at preventative health visits. Integration using similar approaches may benefit other institutions interested in providing standardized SUD screening.

Urine Drug Test Results Among Adolescents and Young Adults in an Outpatient Office-Based Opioid Treatment Program.

PURPOSE: Urine drug testing (UDT) is an important feature of outpatient treatment for opioid use disorder, but associations with patient characteristics among adolescent and young adult patients are unknown. This study assessed UDT results in office-based opioid treatment and characteristics associated with treatment compliance. METHODS: This was a retrospective study of adolescent and young adult patients enrolled in office-based opioid treatment between January 1, 2009, and December 31, 2020. UDT results were described as positive results or expected and unexpected results. Expected results were negative UDTs for opioids, marijuana (THC [tetrahydrocannabinol]), or cocaine/methamphetamine, or a positive UDT for buprenorphine. Unexpected results were positive UDTs for opioids, THC, or cocaine/methamphetamine, or a negative UDT for buprenorphine. Treatment compliance was defined as ≥75% of UDTs provided being expected results. Counts and percentages described UDT results. Regressions evaluated associations between patient characteristics (retention time, age, sex, race/ethnicity, insurance, and comorbid mental health diagnoses) with treatment compliance, and assessed change of positivity rates for UDTs over time. RESULTS: A total of 407 patients were included. Overall, 305 patients (74.9%) demonstrated treatment compliance. Rates of expected UDT results increased with longer retention time (p <.001), except for methamphetamine. Buprenorphine expected results ranged from 77.0% to 96.5%. Diagnosis of stimulant use disorder was associated with decreased compliance (p = .04), while diagnoses of depression, anxiety, nicotine use disorder, and post-traumatic stress disorder were associated with increased compliance (p ≤.04). DISCUSSION: Proportion of expected UDT results increased with retention time. Diagnosis of specific mental health conditions affected treatment compliance. Further research regarding long-term health outcomes is needed.

Gaps in Evidence-based Treatment of Concurrent Attention Deficit Hyperactivity Disorder and Opioid Use Disorder: A Scoping Review.

OBJECTIVES: To describe the effectiveness of medications for the treatment of opioid use disorder (OUD) and attention deficit/hyperactivity disorder (ADHD). DATA SOURCES: Literature search of PubMed, Embase, Web of Science, CINAHL, Medline, PsycINFO, and Google Scholar was performed for studies published from inception to October 25, 2022. STUDY SELECTION AND DATA EXTRACTION: Studies were included if patients were diagnosed with OUD and ADHD and had pharmacotherapy for either condition. Abstracts, commentaries, reviews, case reports, case series, non-English articles, and animal studies were omitted. DATA SYNTHESIS: This review found 18 studies. Treatment of ADHD was evaluated for impact on ADHD and OUD outcomes, while treatment of OUD was evaluated for OUD-related outcomes. Outcomes assessed included markers for symptom intensity, adherence, and treatment failure. While results were mixed, treatment of ADHD was largely associated with improvements in ADHD severity and retention in OUD treatment programs. ADHD severity was associated with higher rates of illicit substance abuse and worse OUD-related outcomes. It could not be determined which medications for treatment of OUD should be prioritized. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: This review summarized key findings from studies that treated ADHD or OUD among dually diagnosed patients and highlighted methodological considerations for future research. CONCLUSIONS: Treatment of ADHD is warranted among patients with OUD and ADHD to improve retention in OUD treatment programs and reduce illicit substance abuse. Pharmacotherapy for the treatment of ADHD or OUD should continue to be determined based on patients' characteristics and the capabilities of the treatment program.

Omega-3 fatty acids and autonomic function in adolescents with anorexia: A randomized trial.

OBJECTIVES: Patients with anorexia nervosa (AN) have autonomic nervous system (ANS) dysfunction as measured by heart rate variability (HRV). Omega-3 fatty acids may improve heart rate regulation. Our aim was to describe ANS response to a mid-day meal in adolescent females with AN in a 12-week treatment program, randomized to receive either omega-3 supplements or placebo. METHODS: This pilot study was a longitudinal, double-blind, randomized controlled trial. Each group was subdivided into an acutely ill cohort and a chronically ill cohort. Linear and non-linear measures of slope, mean, and pre/post-meal changes in HRV were measured at baseline, 6 weeks, and 12 weeks. RESULTS: Twenty-four women (n = 12 placebo; n = 12 omega-3) were enrolled. By program end, the acute omega-3 group alone showed no change in any pre-meal slope. Acute and chronic omega-3 groups, but not placebo groups, demonstrated physiologically expected post-meal heart rate increases at 12 weeks. For all measures at 6 and 12 weeks, the chronic placebo and omega-3 groups had smaller physiologic responses to the meal compared with the acute groups. CONCLUSIONS: Participation in a 12-week partial hospitalization program may improve autonomic function in response to mealtime, with possible additional benefit from omega-3 PUFA, particularly in those with acute illness. IMPACT: Autonomic function with meals improves with a 12-week partial hospitalization program in adolescent females with anorexia nervosa. Omega-3 polyunsaturated fatty acids may improve autonomic function, especially in adolescent females with acute forms of anorexia nervosa. Longer duration of illness in adolescent females with anorexia nervosa is associated with blunted autonomic response to meals.