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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

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Abstract

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.

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Funding

This research was supported by two initiatives from NIH/NIDA: the HEAL Prevention Cooperative and the Justice Community Opioid Innovation Network initiatives. The authors received collaborative contributions from NIDA and support from the following awards: Indiana University (UG1DA050070; PI Matthew Aalsma); Ohio State University (UG3/UH3050174; MPIs Natasha Slesnick, Kelly Kelleher); Texas Christian University (UG3/UH3DA050250; PI Danica Kalling Knight); Seattle Children’s Hospital/University of Washington (UG3/UH3DA050189; MPIs Kym Ahrens, Kevin Haggerty).

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Authors and Affiliations

  1. Seattle Children’s Hospital and Research Institute, Seattle, WA, USA

    Kym Ahrens

  2. RTI International, Research Triangle Park, Raleigh, NC, USA

    Natalie Blackburn

  3. Indiana University School of Medicine, Indianapolis, IN, USA

    Matthew Aalsma

  4. University of Washington Social Development Research Group, Seattle, WA, USA

    Kevin Haggerty

  5. Nationwide Children’s Hospital, Columbus, OH, USA

    Kelly Kelleher

  6. Texas Christian University Karyn Purvis Institute of Child Development, Fort Worth, TX, USA

    Danica K. Knight

  7. Texas Christian University Institute of Behavioral Research, Fort Worth, TX, USA

    Elizabeth Joseph

  8. National Institute on Drug Abuse, Bethesda, MD, USA

    Carrie Mulford

  9. Washington State Dept. of Children, Youth and Families/Juvenile Rehabilitation, Olympia, WA, USA

    Ted Ryle

  10. University of California San Francisco Weill Institute for Neurosciences, San Francisco, CA, USA

    Marina Tolou-Shams

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Correspondence to Kym Ahrens.

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Ethics Approval

All procedures involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The ADAPT study was approved by Indiana University Purdue University Indianapolis Institutional Review Board (1910282231); the HOME study was approved by The Ohio State Behavioral and Social Sciences Institutional Review Board (2019B0287); the LeSA study was approved by Texas Christian University Institutional Review Board (1920–219); the POST study was approved by the Washington State Institutional Review Board (2019–131-DCYF).

Informed Consent

Informed consent was obtained from all participants included in the studies. For youth under 18, parental consent was obtained unless a waiver was granted by the relevant institutional review board.

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Ahrens, K., Blackburn, N., Aalsma, M. et al. 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. Prev Sci 24 (Suppl 1), 99–110 (2023). https://doi.org/10.1007/s11121-023-01566-6

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