The Association of Vaping With Social/Emotional Health and Attitudes Toward COVID-19 Mitigation Measures in Adolescent and Young Adult Cohorts During the COVID-19 Pandemic.

BACKGROUND: Vaping is a major health risk behavior which often occurs socially. Limited social activity during the COVID-19 pandemic contributed to worsening social and emotional health. We investigated associations among youth vaping, and reports of worsening mental health, loneliness, and relationships with friends and romantic partners (ie, social health), as well as perceived attitudes toward COVID-19 mitigation measures. METHODS: From October 2020 to May 2021, a clinical convenience sample of adolescents and young adults (AYA) reported on their past-year substance use, including vaping, their mental health, COVID-19 related exposures and impacts, and their attitudes toward non-pharmaceutical COVID-19 mitigation interventions, via a confidential electronic survey. Multivariate logistic regressions were used to estimate associations among vaping and social/emotional health. RESULTS: Of 474 AYA (mean age = 19.3 (SD = 1.6) years; 68.6% female), 36.9% reported vaping in the prior 12 months. AYA who self-reported vaping were more likely than non-vaping AYA to report worsening: anxiety/worry (81.1%; P = .036), mood (78.9%; P = .028), eating (64.6%; P = .015), sleep (54.3%; P = .019), family discord (56.6%; P = .034), and substance use (54.9%; P < .001). Participants who vaped also reported easy access to nicotine (63.4%; P < .001) and cannabis products (74.9%; P < .001). No difference in perceived change in social wellbeing was seen between the groups. In adjusted models, vaping was associated with symptoms of depression (AOR = 1.86; 95% CI = 1.06-3.29), less social distancing (AOR = 1.82; 95% CI = 1.11-2.98), lower perceived importance of proper mask wearing (AOR = 3.22; 95% CI = 1.50-6.93), and less regular use of masks (AOR = 2.98; 95% CI = 1.29-6.84). CONCLUSIONS: We found evidence that vaping was associated with symptoms of depression and lower compliance with non-pharmaceutical COVID-19 mitigation efforts among AYA during the COVID-19 pandemic.

The Impact of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic on Substance Use in the United States.

The SARS-CoV-2 pandemic has been associated with dramatic increases in substance use, as marked by increased alcohol, nicotine, and cannabis sales. Lethal opioid overdoses also increased dramatically, especially during the initial phases of the epidemic when lockdowns and social isolation combined with increasing fentanyl contamination of the illicit drug supply resulted in more overdoses and fewer opportunities for rescue. Substance use, and especially inhalational drug use, increases the likelihood of both transmission and severe infection. Youth are especially vulnerable to substance use and have increased risk of long-term problems. These outcomes highlight the need for greater access to substance use treatment. Virtual treatment, which emerged as a promising format during the pandemic, may reduce access barriers. This article reviews trends in substance use during the pandemic, explores root causes of increased use and overdose, and examines the potential to increase treatment through virtual care, especially during future periods of disruption.

Acceptability of a Fentanyl Vaccine to Prevent Opioid Overdose and Need for Personalized Decision-Making.

BACKGROUND: The opioid epidemic worsened during the coronavirus disease 2019 (COVID-19) pandemic. Synthetic opioids (primarily fentanyl) comprise the most common drugs involved in overdose (OD) death. A vaccine that blocks fentanyl from reaching the brain to prevent OD is under development, and insight is needed into its acceptability. METHODS: Using a semi-structured interview guide, persons with opioid use disorder (OUD), family, professionals, and the public were interviewed about attitudes and concerns regarding a fentanyl vaccine. Reactions to fictional clinical vignettes of persons at risk of OUD because of pain and/or substance use histories were collected, analyzed, and quantified for favorability. Interviews were transcribed, coded, and analyzed thematically. RESULTS: Among N = 64 participants, (70.3% female, average age 32.4 years), attitudes were favorable toward a fentanyl vaccine, with preference for lifelong durability (76% of n = 55 asked). Perceived benefits centered on the potential for a life-saving intervention, suffering averted, healthcare dollars saved, and the utility of a passive harm reduction strategy. Concerns centered on uncertainty regarding vaccine safety, questions about efficacy, worry about implications for future pain management, stigma, and need for supportive counseling and guidance to personalize decision making. Reactions to vignettes revealed complex attitudes toward fentanyl vaccination when considering recipient age, health history, and future risks for addiction and pain. CONCLUSIONS: Positive responses to a fentanyl vaccine were found along with appreciation for the complexity of a vaccine strategy to prevent OD in the setting of pain and uncertain durability. Further research is needed to elucidate operational, ethical, and communications strategies to advance the model.

Coronavirus disease pandemic and adolescent substance use.

PURPOSE OF REVIEW: Substance use is common in adolescence and has distinct developmental, cognitive, and health consequences. Over the last 2 years, the coronavirus disease 2019 pandemic has isolated adolescents, disrupted typical developmental milestones, and caused pervasive stress and anxiety. Healthcare providers can help by recognizing and addressing these effects on adolescent mental health and substance use. This update reviews the immediate effects of the pandemic on adolescent substance use, potential future implications, and opportunities to use new strategies to improve care for adolescents with problematic use. RECENT FINDINGS: Initial findings suggest that fewer teens started using substances during the pandemic. This was likely influenced by stay at home orders that reduced opportunities for social use. However, increased time at home was not beneficial for all adolescents. Furthermore, adolescents who used substances prepandemic, experienced material hardship, or reported higher pandemic-related stress tended to intensify substance use during this time. SUMMARY: The adverse effects of pandemic isolation, anxiety, and developmental disruption will likely have consequences for adolescent substance use for many years to come. To comprehensively address adolescent health, healthcare providers can be sensitive to these realities and use existing screening and brief intervention strategies to address use. Innovative telehealth strategies that allow for the expansion of substance use treatment offer promising opportunities to improve care for adolescents with substance use disorder.

Trends in cannabis-related attitudes and behaviors among cannabis-using adolescent and young adult outpatients following medical cannabis legalization in Massachusetts.

Background: Among youth already using cannabis, legalization of medical cannabis may influence cannabis-related attitudes and behaviors, including increasing access through use of someone else's medical cannabis (diversion). Objective: To examine cannabis-related attitudes and behaviors (including diverted cannabis use) in cannabis-using youth in the four years following medical cannabis legalization. Additionally, we investigated characteristics of youth who used vs. did not use diverted medical cannabis. Methods: Data were collected in Boston from 2013 (when medical cannabis legislation took effect in Massachusetts) through 2016 (when recreational cannabis use became legal in Massachusetts). Cannabis-using youth (age 13-24) presenting to an outpatient adolescent substance use treatment program (ASUTP) or recruited for an adolescent medicine clinic study (AMCS) completed a confidential survey on demographic characteristics and cannabis use behaviors and attitudes. We used multiple logistic regression to analyze changes in attitudes and behaviors over three years versus the reference year (2013), controlling for demographics. We used chi-square to compare characteristics of youth reporting use of diverted medical cannabis versus those not. Results: The sample included 273 cannabis-using youth (ASUTP n = 203, AMCS n = 70; 2013 n = 67, 2014 n = 67, 2015 n = 77, 2016 n = 62). Mean ± SD age was 18.2 ± 2.5 years, 32% were female, 58% were White non-Hispanic, and 70% had college-graduate parents. In 2013, most youth reported that cannabis was easy to obtain (97.9%), and that occasional cannabis use had "no" or "slight" risk of harm (89.4%), with little change across years. In 2016, 44% of youth reported using someone else's medical cannabis, versus 15% in 2013 (aOR 4.66, 95% CI 1.81, 11.95). Youth using diverted medical cannabis had higher likelihood of reporting riding with a driver, or driving themselves, after cannabis use (both p < .01). Conclusion: Among at-risk youth in Massachusetts, use of diverted medical cannabis increased after medical cannabis legalization, and those using diverted medical cannabis reported higher risk for cannabis-related traffic injury.

Rates and predictors of substance use in pediatric primary care clinics.

Background: Screening for substance use within pediatric primary care provides a unique opportunity to identify adolescents in need of intervention. Methods: This study analyzed screening data collected across 13 Federally Qualified Health Centers over the course of an 18-month project designed to implement Screening Brief Intervention Referral to Treatment (SBIRT) for adolescents aged 12-21. A mixed-effects modeling strategy was used to describe associations between demographic, procedural, and clinical factors and adolescent reports of substance use. Results: In total, 10,813 adolescents were screened between December 2017 and May 2019, with 17% reporting past year use, including 11% at lower risk and 6% at high risk of a substance use disorder. Females, Hispanic, Black/African American, heterosexual, non-primary English speakers, and patients who did not have a co-occurring mental health disorder were all less likely to report past year substance use. While rates of disclosing any past year substance use were equivalent between patients screened by a staff member and those who completed self-administered screens, patients who were screened by a staff member were associated with reporting overall greater frequencies of use. Patients who were screened by a staff member with a parent present were less likely to disclose any past year substance use. Conclusion: While overall rates of disclosure of any past year substance use (17.2%) were lower than reported in research settings, a substantial proportion (6.3%) had screen results indicating a high risk for substance use disorder.

Towards an International Consensus on the Prevention, Treatment, and Management of High-Risk Substance Use and Overdose among Youth.

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.

Reduced humoral response to mRNA SARS-CoV-2 BNT162b2 vaccine in kidney transplant recipients without prior exposure to the virus.

COVID-19 is associated with increased morbidity and mortality in transplant recipients. There are no efficacy data available regarding these patients with any of the available SARS-CoV-2 vaccines. We analyzed the humoral response following full vaccination with the BNT162b2 (Pfizer-BioNTech) in 136 kidney transplant recipients, and compared it to 25 controls. In order to exclude prior exposure to the virus, only participants with negative serology to SARS-CoV-2 nucleocapsid protein were included. All controls developed a positive response to spike protein, while only 51 of 136 transplant recipients (37.5%) had positive serology (p < .001). Mean IgG anti-spike level was higher in the controls (31.05 [41.8] vs. 200.5 [65.1] AU/mL, study vs. control, respectively, p < .001). Variables associated with null humoral response were older age (odds ratio 1.66 [95% confidence interval 1.17-2.69]), high-dose corticosteroids in the last 12 months (1.3 [1.09-1.86]), maintenance with triple immunosuppression (1.43 [1.06-2.15]), and regimen that includes mycophenolate (1.47 [1.26-2.27]). There was a similar rate of side effects between controls and recipients, and no correlation was found between the presence of symptoms and seroconversion. Our findings suggest that most kidney transplant recipients remain at high risk for COVID-19 despite vaccination. Further studies regarding possible measures to increase recipient's response to vaccination are required.

Hepatitis C related cognitive impairment: Impact of viral and host factors and response to therapy.

Chronic hepatitis C virus (HCV) infection is associated with cognitive impairment via several suggested mechanisms including direct neurotoxicity and minimal hepatic encephalopathy. The prevalence of HCV-related cognitive impairment and whether it is reversed by anti-viral therapy is unknown. We aimed to assess predictors and reversibility of cognitive impairment of HCV-infected patients after successful treatment. Consecutive HCV patients treated during the EMERALD study (AbbVie 3D regimen for protease inhibitors failure) underwent neuropsychological (number connection test A [NCTA] and digital symbol test [DST]) and neurophysiological (critical flicker frequency [CFF]) tests at baseline and at 12 weeks post-treatment. Patient self-reported outcomes (PROs) were prospectively collected. Patients with a history of hepatic encephalopathy were excluded. Thirty-two patients underwent the cognitive tests at baseline. Seven of them had abnormal CFF test findings. Twenty-five (25/32, 78%) patients had repeated evaluations 3 months post-treatment. High viral loads were significantly associated with abnormal CFF across fibrosis levels (area under the ROC curve 0.817). CFF results significantly improved following viral eradication, from 40.9 (interquartile range 38.6-42.9) at baseline to 41.5 (39.8-44), p = .042, at follow-up. Both NCTA and DST results improved, but not significantly. There was improvement in the PROs of general health perception and vitality. The NCTA and DST results were more significantly associated with PROs than CFF. This prospective interventional study showed greater cognitive impairment in HCV patients with high viral load and demonstrated partial reversibility of HCV neurotoxicity and subsequent improvement in PROs following treatment.

Kidney transplant recipients vaccinated before transplantation maintain superior humoral response to SARS-CoV-2 vaccine.

Majority of transplant recipients did not develop an appreciable humoral response following SARS-CoV-2 vaccine, in contrast to dialysis patients and healthy individuals. We analyzed the serologic response to BNT162b2 (Pfizer-BioNTech) vaccine in a cohort of 19 kidney transplant recipients, vaccinated prior to transplantation, compare to 109 recipients vaccinated after transplantation, and to 39 healthcare workers, by determining the level of anti-spike antibodies after transplantation. All controls and 17 of 19 (90%) of recipients vaccinated before transplant were seropositive, while only 49 of 109 (45%) recipients vaccinated post-transplant had positive serology (P < .001). Median anti-spike IgG in the group of kidney transplant recipients vaccinated after transplantation (10.7 AU/ml, [IQR 0-62.5]) was lower than the patients vaccinated before transplantation (66.2 AU/ml [21.6-138]), which was significantly lower than in the controls (156 AU/ml [99.7-215.5]). Negative humoral response was associated with vaccination post transplantation (odds ratio 22.4), older age (OR = 1.04), and longer time on dialysis (OR = 1.02), while higher lymphocyte count at time of vaccination was protective (OR = .52). Our findings of sustained superior humoral response to SARS-CoV-2 vaccine in kidney transplant recipients vaccinated prior to transplantation strongly support the recommendations of SARS-CoV-2 vaccination of transplant candidates, especially those younger than 60 years.

Psychoeducational Messaging to Reduce Alcohol Use for College Students With Type 1 Diabetes: Internet-Delivered Pilot Trial.

BACKGROUND: College environments promote high-volume or binge alcohol consumption among youth, which may be especially harmful to those with type 1 diabetes (T1D). Little is known about the acceptability and effectiveness of interventions targeting reduced alcohol use by college students with T1D, and it is unclear whether intervention framing (specifically, the narrator of intervention messages) matters with respect to affecting behavior change. Interventions promoted by peer educators may be highly relatable and socially persuasive, whereas those delivered by clinical providers may be highly credible and motivating. OBJECTIVE: The aim of this study is to determine the acceptability and impacts of an alcohol use psychoeducational intervention delivered asynchronously through web-based channels to college students with T1D. The secondary aim is to compare the impacts of two competing versions of the intervention that differed by narrator (peer vs clinician). METHODS: We recruited 138 college students (aged 17-25 years) with T1D through web-based channels and delivered a brief intervention to participants randomly assigned to 1 of 2 versions that differed only with respect to the audiovisually recorded narrator. We assessed the impacts of the exposure to the intervention overall and by group, comparing the levels of alcohol- and diabetes-related knowledge, perceptions, and use among baseline, immediately after the intervention, and 2 weeks after intervention delivery. RESULTS: Of the 138 enrolled participants, 122 (88.4%) completed all follow-up assessments; the participants were predominantly women (98/122, 80.3%), were White non-Hispanic (102/122, 83.6%), and had consumed alcohol in the past year (101/122, 82.8%). Both arms saw significant postintervention gains in the knowledge of alcohol's impacts on diabetes-related factors, health-protecting attitudes toward drinking, and concerns about drinking. All participants reported significant decreases in binge drinking 2 weeks after the intervention (21.3%; odds ratio 0.48, 95% CI 0.31-0.75) compared with the 2 weeks before the intervention (43/122, 35.2%). Changes in binge drinking after the intervention were affected by changes in concerns about alcohol use and T1D. Those who viewed the provider narrator were significantly more likely to rate their narrator as knowledgeable and trustworthy; there were no other significant differences in intervention effects by the narrator. CONCLUSIONS: The intervention model was highly acceptable and effective at reducing self-reported binge drinking at follow-up, offering the potential for broad dissemination and reach given the web-based format and contactless, on-demand content. Both intervention narrators increased knowledge, improved health-protecting attitudes, and increased concerns regarding alcohol use. The participants' perceptions of expertise and credibility differed by narrator. TRIAL REGISTRATION: ClinicalTrials.gov NCT02883829; https://clinicaltrials.gov/ct2/show/NCT02883829. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1177/1932296819839503.

Implementing adolescent SBIRT: Findings from the FaCES project.

Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach to early intervention of substance misuse. Methods: This mixed-methods evaluation assessed the implementation of an adolescent SBIRT change package across 13 primary care clinics. These clinics participated in an 18-month learning collaborative, during which they received training and technical assistance on SBIRT practices. Results: Six major themes emerged around the implementation of the change package: operational readiness of the sites, training of staff members, factors around the screening process, factors around intervention delivery, the referral process, and the adaptation and utilization of the electronic health record (EHR). Conclusions: Through the guidance of the change package and the associated training and technical assistance, the participating primary care clinics were able to implement SBIRT practices within their existing workflows. There was also an observed reduction in reported substance use among the at-risk adolescents served by these clinics.

Sensitivity and specificity of S2BI for identifying alcohol and cannabis use disorders among adolescents presenting for primary care.

BACKGROUND: The Screening to Brief Intervention (S2BI) tool was designed to identify substance use disorders in adolescents. We report the S2BI's sensitivity and specificity for identifying alcohol and cannabis use disorders (AUD and CUD) in adolescents presenting for primary care. Methods: Participants aged 14-18 (N = 517) completed an electronic survey, consisting of the S2BI, the Composite International Diagnostic Interview (CIDI), and anxiety and depression screens. We calculated sensitivity, specificity, and positive and negative predictive value (PPV, NPV) of the S2BI compared to the CIDI criterion standard, using past year "monthly" and "weekly or more" consumption of alcohol or marijuana as a threshold for AUD or CUD. Results: Current AUD and CUD were present in 2.9% and 8.3% of the sample, respectively and severe AUD and CUD were present in 0.8% and 3.9%. The S2BI had 53.3% sensitivity and 94.2% specificity for identifying any AUD (PPV = 21.6%; NPV = 98.5%), and 81.4% sensitivity and 92.0% specificity for identifying any CUD (PPV = 47.9%; NPV = 98.2%). The same threshold had 100% sensitivity and 93.6% specificity for identifying moderate/severe AUD, and 90.0% sensitivity and 89.0% specificity for identifying moderate/severe CUD. Conclusions: S2BI had excellent sensitivity and specificity for identifying moderate and severe AUD and CUD. Sensitivity decreased when mild AUD and CUD were included.

Dismantling racism against Black, Indigenous, and people of color across the substance use continuum: A position statement of the association for multidisciplinary education and research in substance use and addiction.

The Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) acknowledges that racism profoundly affects persons who use alcohol and other drugs. Racism's deadly effects compounded with other social determinants of health result in a cascade of negative impacts. The AMERSA Board of Directors (BOD) proposes an initial set of strategies to promote diversity, equity, and inclusion using a framework that speaks to four key AMERSA experiences: engagement, education, mentorship, and leadership. Through these strategies, AMERSA commits to promoting equity and inclusion to dismantle the individual, institutional, and structural racism that has permeated the United States for centuries.

Moving beyond perceived riskiness: Marijuana-related beliefs and marijuana use in adolescents.

Background: Perceived riskiness of marijuana in adolescents has been trending downward in the context of increasing legality and availability. Low perceived riskiness has been associated with marijuana use though evidence is lacking on associations among use and more specific claims about marijuana's safety and benefit, improved understanding of which could guide clinical interventions to reduce use. Methods: We analyzed cross-sectional survey data collected from 502 adolescents aged 14-18 years recruited from an urban adolescent primary care clinic. Self-report questionnaires were administered via tablet computer. Use of marijuana was assessed with a brief validated screening tool, and agreement with each of five statements about marijuana's riskiness and health properties were reported using a four-point Likert scale. We conducted multivariable logistic regressions to determine the association between perceived riskiness and other marijuana-related beliefs and past-year marijuana use. Results: In total, 149 adolescents reported past-year marijuana use (29.7%). High overall perceived risk was associated with lower rates of past-year use (AOR 0.27, 95%CI: 0.15-0.48). Agreement with positive health beliefs that "marijuana can help teenagers focus in school" and that "marijuana is safe because it's natural" were associated with past-year marijuana use (respectively, AOR 5.50, 95%CI: 3.06-9.88 and AOR 6.61, 95%CI: 3.59-12.19) while agreement with negative health beliefs that "marijuana can affect youth even after they don't feel high anymore" and that "marijuana can be addictive" were both associated with lower rates of use (AOR 0.56, 95%CI: 0.31-0.99, and AOR 0.30, 95%CI: 0.16-0.56, respectively), adjusting for sociodemographic factors and use of other substances. Conclusions: Marijuana use varied in association with beliefs about its beneficial and harmful health properties. Clinical interventions that target specific marijuana-related health beliefs including unfounded claims of benefit may provide robust talking points for centering provider guidance and public health messaging.

An in vitro evaluation of marginal fit zirconia crowns fabricated by a CAD-CAM dental laboratory and a milling center.

BACKGROUND: Marginal fit is critical for the success and longevity of a dental restoration. Zirconia crowns can be fabricated either chair-side, in a dental laboratory or in a milling center; each can give different marginal fits results. However, discussion of the marginal fit of zirconia crowns when different fabrication methods are compared is lacking in the literature. PURPOSE: To compare the marginal discrepancy (MD) and absolute marginal discrepancy (AMD) of computer-aided design, and computer-aided manufacturing (CAD-CAM) used in a dental laboratory and a milling center for producing monolithic zirconia crowns. METHODS: The marginal fit of 30 zirconia crowns cemented to typodont teeth was evaluated by means of a sectioning technique. Fifteen crowns were fabricated with a CEREC inLAB MC X5 from IPS e.max ZirCAD blocks. Fifteen crowns were fabricated using a LAVA milling center from LAVA Plus Zirconia Blocks. The 30 crowns were sectioned with a precision saw, and MD and AMD were subsequently measured using a light microscope. Data were analyzed using the one-way ANOVA technique to investigate significant differences in the marginal fit between the two fabrication systems (α = .05). RESULTS: The AMD dimension of the CEREC inLAB system was significantly smaller (P < .05). Mean AMD values for zirconia crowns fabricated by the CEREC inLAB were 85 µm, and for the LAVA milling center 133 µm. There was no significant difference between the two systems regarding the MD dimensions. The MD values for zirconia crowns fabricated by the CEREC inLAB were 53 µm and for the LAVA milling center 61 µm. CONCLUSIONS: The CEREC inLAB system demonstrated significantly better marginal fit in relation to the AMD. However, no difference between the systems was found in the MD. Monolithic zirconia crowns fabricated by the CAD-CAM CEREC inLAB system and the LAVA system milling center showed MD values of less than 120 µm, which is within the clinically acceptable range.

A novel approach to treating adolescents with opioid use disorder in pediatric primary care.

BACKGROUND: Medication treatment for opioid use disorder is effective, and recommended for adolescents, though very few adolescents with opioid use disorder ever receive medications. Reasons include lack of trained medication prescribers for this age group and difficulty in identifying adolescents with substance use disorders. This manuscript examines a novel implementation model of identifying and providing treatment for substance use disorders, including opioid use disorder, in a pediatric primary care practice. METHODS: Patients presenting to a selected primary care pediatrics practice for any reason between March 9, 2017 and July 24, 2017 that were identified by screening, self-report or other clinical information to have a substance use problem were referred to an integrated clinical social worker for treatment. We recorded the number of patients that were referred, number of visits completed and SUD and mental health diagnoses. RESULTS: In the first 4 months of this program, 683 patients aged 12-22 completed a health maintenance appointment; 20 were referred for substance use disorder treatment and 13 completed at least one substance use disorder treatment visit with the integrated clinical social worker. The mean number of visits completed was 5.3. Three patients with opioid use disorders were identified and 2 were induced on buprenorphine. CONCLUSIONS: Our model for treatment of substance use disorders, including opioid use disorders, was feasible and acceptable in a pediatric primary care practice. Broadly implemented, such a model could substantially increase access to substance use disorder treatment for adolescents and young adults.

Screening and brief intervention in high schools: School nurses' practices and attitudes in Massachusetts.

BACKGROUND: Screening, brief intervention, and referral to treatment (SBIRT) is recommended as a strategy to prevent or reduce adolescent substance use. Offering SBIRT in schools may provide an opportunity to reach adolescents not accessing primary care. The objective is to assess school nurses' attitudes and practices regarding adolescent SBIRT. METHODS: The authors administered electronically and in person a questionnaire including 29 items on SBIRT attitudes and practices to school nurses registered for the Northeastern University's School Health Institute Summer Program in Massachusetts (N = 168). Survey questions were adapted from a questionnaire originally developed by the American Academy of Pediatrics. RESULTS: One hundred and forty-four nurses completed the survey for a response rate of 85.7%. More than three quarters of the respondents (77.0%) were in favor of universal alcohol screening in schools. None of the respondents reported screening their students on a regular basis. More than half (64.4%) of nurses reported screening students; however, they did so only when they suspected alcohol use. During these instances, only 17.9% used a validated screening tool and almost all (98.2%) used face-to-face clinical interviews. When addressing alcohol use by a student, the large majority of respondents reported including the following recommended clinical strategies: asking about problems related to alcohol use (56.3%), explaining the harms of alcohol use (70.1%), and advising abstinence (73.6%). On average, respondents spend 5 to 10 minutes discussing alcohol use with their students. CONCLUSION: Survey respondents were supportive of universal alcohol screening in school, although few were doing so at the time. When respondents identified students using alcohol, their interventions were closely aligned with clinical recommendations for brief intervention. Implementation of SBIRT that focuses on standardized, annual screening has the potential to deliver high-quality care in this setting.

The Surgeon General's Facing Addiction report: An historic document for health care.

The publication of Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health presents an historic moment not only for the field of addiction medicine, but also for the United States as a nation. The Board of Directors of the Association for Medical Education and Research in Substance Abuse (AMERSA), on behalf of our organization, would like to express our appreciation of the efforts of Dr. Vivek Murthy and the Surgeon General's Office to publish the first surgeon general's report covering substance misuse and substance use disorders.