Prescription drug misuse among homeless youth

The global prevalence of mental health disorders among runaway and homeless youth: A meta-analysis

A meta-analysis was performed to identify the pooled prevalence of mental health disorders (MHDs) among runaway and homeless youth (RHY). Relevant studies published between December 1, 1985, and October 1, 2023, were identified in the PubMed, Scopus, Web of Science, and Cochrane Library databases. A preliminary screening of 11,266 papers resulted in the inclusion of 101 studies. The pooled-prevalence estimates were obtained using a random-effects model. The findings showed varying lifetime prevalence rates of MHDs: 47% (conduct disorders and psychological distress), 43% (depression), 34% (major depressive disorders), 33% (post-traumatic stress disorder), 27% (personality disorders), 25% (attention-deficit/hyperactivity disorder), 23% (bipolar disorders), 22% (anxiety), 21% (oppositional defiant disorders), 15% (anorexia), 15% (adjustment disorders), 14% (dysthymia), 11% (schizophrenia), 9% (obsessive-compulsive disorders), and 8% (gambling disorder). The current prevalence rates were: 31% (depression), 23% (major depressive disorder), 23% (anxiety), 21% (post-traumatic stress disorder), 16% (attention-deficit/hyperactivity disorder), 15% (bipolar disorder), 13% (personality disorders), 13% (oppositional defiant disorders), 8% (schizophrenia), and 6% (obsessive-compulsive disorders). Regular screening and the implementation of evidence-based treatments and the promotion of integration and coordination between mental health services for adolescent minors and young adults with other service systems are recommended.

Understanding Homelessness Among Young People to Improve Outcomes

In the United States, an estimated 4.2 million young people experience homelessness during critical stages in their development-adolescence and emerging adulthood. While research on youth homelessness often emphasizes risk and vulnerability, the field must situate these issues within the developmental trajectories of adolescence and emerging adulthood to effectively prevent and end youth homelessness. This review uses the Risk Amplification and Abatement Model (RAAM) as a conceptual framework for contextualizing the landscape of youth homelessness research in the United States since 2010. An extension of ecological models of risk-taking, RAAM emphasizes both risk and resilience, positing that negative as well as positive socialization processes across interactions with family, peers, social services, and formal institutions affect key housing, health, and behavioral outcomes for youth experiencing homelessness. This review applies RAAM to our understanding of the causes and consequences of youth homelessness, recent interventions, and recommendations for future directions.

Substance use typologies among young people experiencing homelessness in seven cities across the United States: A latent class analysis

BACKGROUND

Substance use and other health-risk risk factors, including mental health, trauma, and sexual-risk behaviors, often co-occur among youth experiencing homelessness (YEH). The present study aimed to identify subgroups of YEH based on polysubstance use and the linkages to sociodemographic and health-risk characteristics.

METHODS

From June 2016 to July 2017, 1,426 YEH (aged 18-26 years) were recruited from seven cities (Houston, Los Angeles, Denver, Phoenix, New York City, St. Louis, San Jose). Participants provided information via a self-administered electronic survey on substance use, mental health, trauma, sexual risk behaviors, and sociodemographic characteristics. The majority of YEH identified as Black (37.3%), cisgender (92.8%), and heterosexual (69.2%). On average, YEH were 20.9 years (SD = 2.1). This study employed latent class analysis (LCA) to identify subgroups of YEH according to their substance use. Multinomial logistic regression analyses were conducted to identify sociodemographic and health-risk characteristics associated with class-membership.

RESULTS

Four latent classes of YEH substance use were identified: (1) high polysubstance use; (2) moderate stimulant and high marijuana, alcohol, and prescription drug use; (3) high marijuana, alcohol, and prescription drug use; (4) low/moderate marijuana and alcohol use. Multinomial logistic regression models indicated that geographic location, gender, race/ethnicity, mental health, trauma history, and sexual risk behaviors were significant correlates of substance use class membership among YEH.

CONCLUSIONS

These findings offer important implications for the prevention and treatment of substance use among YEH. Screening protocols should consider co-occurring risk factors such as traumatic experiences, sexual risk behaviors, and mental health history as indicators of polysubstance use.

Examining the Role of Duration and Frequency of Homelessness on Health Outcomes Among Unsheltered Young Adults

PURPOSE

We examined the impact of duration and number of homelessness episodes on health outcomes for unsheltered homeless young adults.

METHODS

We analyzed the 2018/2019 Los Angeles County homeless youth demographic surveys. We addressed five summary health outcomes: physical health, mental health, substance use disorder, tri-morbidity, and any condition. Respondents were classified into three homeless trajectory groups: (1) short-term-homeless < 1 year in one episode, (2) episodic-homeless < 1 year and multiple episodes, and (3) long-term-homeless continuously for > 1 year. Weighted bivariate and multivariate logistic regression models tested the relationship between homeless trajectory group and health, with controls for sociodemographic factors and structural exposures.

RESULTS

Mental health and substance use were high among unsheltered young adults compared to national rates. Long-term homeless respondents were significantly more likely than short-term to report a mental health condition (53.3% vs. 39.8%, p < .001), substance use disorder (25.5% vs. 18.3%, p < .001), and physical conditions (26.0% vs. 15.6%, p = .008). Episodic respondents were more likely to report a mental health condition (50.5%, p < .001). In multivariate models, long-term respondents had twice the odds of tri-morbidity (odds ratio [OR] = 2.14, p < .05) and any health condition (OR 2.00, p < .01) as short term and significantly higher odds of a physical health condition (OR = 1.64, p < .05).

DISCUSSION

Youth with longer durations and more frequent episodes of homelessness have substantially poorer health outcomes. The association of longer duration to poorer health persisted in multivariate models. Longer duration of unsheltered homelessness may drive the onset of physical and mental health problems.

Lessons learned from housing first, rapid rehousing trials with youth experiencing homelessness

BACKGROUND

Youth, 18 to 24 years, experiencing homelessness (YEH) are recognized as having developmental challenges dissimilar to older adults. Yet, research on efforts to end homelessness and prevent or intervene in drug use and mental health problems among youth have lagged behind that of adults. The Housing First (HF) Model which underlies Permanent Supportive Housing (PSH) and Rapid Re-Housing (RRH) has become preferred over treatment-first models.

METHODS AND RESULTS

We provide an overview of PSH and RRH studies to date and summarize our current understanding of their utility for use with YEH. Finally, we review our team's current and past randomized trials testing RRH with YEH, providing lessons learned and recommendations.

CONCLUSION

Current research efforts to guide best practices are hampered by a lack of fidelity to HF principles, lack of randomized design, and lack of focus on youth. Lessons learned and recommendations from our work are offered to facilitate the future work of those who seek to end homelessness and address drug use and mental health problems among youth.

Risk Behaviors and Experiences Among Youth Experiencing Homelessness-Youth Risk Behavior Survey, 23 U.S. States and 11 Local School Districts, 2019

Youth experiencing homelessness experience violence victimization, substance use, suicide risk, and sexual risk disproportionately, compared with their stably housed peers. Yet few large-scale assessments of these differences among high school students exist. The youth risk behavior survey (YRBS) is conducted biennially among local, state, and nationally representative samples of U.S. high school students in grades 9-12. In 2019, 23 states and 11 local school districts included a measure for housing status on their YRBS questionnaire. The prevalence of homelessness was assessed among states and local sites, and relationships between housing status and violence victimization, substance use, suicide risk, and sexual risk behaviors were evaluated using logistic regression. Compared with stably housed students, students experiencing homelessness were twice as likely to report misuse of prescription pain medicine, three times as likely to be threatened or injured with a weapon at school, and three times as likely to report attempting suicide. These findings indicate a need for intervention efforts to increase support, resources, and services for homeless youth.

Runaway History and Past 30-Day Opioid Misuse in Justice-Involved Adolescents

This study used a sample from the Florida Department of Juvenile Justice (n= 79,960) to analyze the association between runaway history and past 30-day opioid misuse (OM) among justice involved adolescents. Past 30-day OM was confirmed using a urine analysis. Adolescents who were runaways in their lifetime were twice as likely to misuse opioids, and those who were runaways at the time of arrest were three times as likely to be opioid misusers compared to adolescents who never ran away or been kicked out of a home. These findings emphasize a need for resources that focus on developing strong attachment bonds.

Housing, opportunities, motivation and engagement (HOME) for homeless youth at-risk for opioid use disorder: study protocol for a randomized controlled trial

Background

Homeless youth experience high rates of substance use disorders, exposures to violence, mental and physical health conditions, and mortality. They have been particularly affected by the opioid crisis. However, no study to date has used a randomized controlled design to test preventive interventions of opioid and other drug use among this vulnerable population. Resolution of youth homelessness through housing and supportive services including prevention services, often referred to as “Housing First,” has great potential to reduce the likelihood for the development of an opioid use disorder as well as other problem behaviors associated with living on the streets. Housing First has been tested through randomized trials among homeless adults with mental health and substance use disorders, but has not been empirically tested for opioid prevention among homeless youth.

Methods

Homeless youth will be recruited from a drop-in shelter site frequented by disconnected youth; they will be screened for eligibility, including current homelessness, age 18–24 years, and not currently meeting criteria for opioid use disorder (OUD). In a controlled trial, 240 youth will then be randomized to one of two conditions, (1) housing + opioid and related risk prevention services, or (2) opioid and related risk prevention services alone. This project utilizes existing efficacious models of prevention to address opioid-related risks, including motivational interviewing, strengths-based outreach and advocacy, and an HIV risk preventive intervention. Follow-up will be conducted at 3, 6, 9 and 12-months post-baseline. The economic cost of each intervention will be determined to support implementation decisions with other providers and their funders.

Discussion

This study will provide essential information for researchers and providers on the efficacy of housing + opioid and related risk prevention services in an RCT for effects on opioid use and mechanisms underlying change. Because youth experiencing homelessness are at increased risk for a variety of adverse outcomes, the proposed intervention may produce substantial health care benefits to the youths and society at large.

Trial registration ClinicalTrials.gov, NCT04135703, Registered October 13, 2019, https://clinicaltrials.gov/ct2/show/NCT04135703?term=NCT04135703&draw=2&rank=1#contacts

Adolescents and opioid-related outcomes amidst the COVID-19 pandemic

Morbidity and mortality attributable to opioid use and misuse among adolescents and young adults are evident. Although recent trend data suggest a decrease in both opioid misuse and opioid use disorder among adolescents and young adults in the last few years, overdose cases continue to rise. The opioid epidemic among this population is complex and has a different profile compared to adults, with family facilitating exposure to opioids more often than other sources. Additionally, despite recommendations by experts to initiate medications for opioid use disorder, few initiate treatment. The recent COVID-19 pandemic has impacted many facets of daily life and its effects on the opioid crisis are largely unknown. Stay-at-home mandates resulting in online schooling and limited social interaction has had deleterious consequences for adolescents, especially their mental health. This viewpoint attempts to explore the effects of the pandemic on the opioid crisis in this vulnerable population.

Medical Comorbidities and Medication Use Among Homeless Adults Seeking Mental Health Treatment

Little is known about the medical conditions and medication use of individuals who are homeless and have mental health problems. This study used secondary data (N = 933) from a mental health clinic serving homeless adults. Primary outcomes were the number and types of self-reported medical conditions and medications. About half (52.60%) of participants were taking one or more medications (mean = 1.67; SD = 2.30), most commonly antidepressants, antipsychotics, and anticonvulsants. Most frequently reported medical conditions were headaches/migraines, hypertension, and arthritis with a mean of 3.09 (SD = 2.74) conditions. Age and sex were significant predictors of the number of medical conditions. Age and the length of time homeless were significant predictors of the number of medications taken. Results suggest that those who are older and have been homeless longer appear to be increased risk for health problems and may need more medications to manage these conditions.

Prescription opioid misuse among adolescents and emerging adults in the United States: A scoping review

The U.S. opioid epidemic is a critical public health problem. As substance use and misuse typically begin in adolescence and emerging adulthood, there is a critical need for prevention efforts for this key developmental period to disrupt opioid misuse trajectories, reducing morbidity and mortality [e.g., overdose, development of opioid use disorders (OUD)]. This article describes the current state of research focusing on prescription opioid misuse (POM) among adolescents and emerging adults (A/EAs) in the U.S. Given the rapidly changing nature of the opioid epidemic, we applied PRISMA Scoping Review (PRISMA-ScR) guidelines to identify empirical articles published in the past 5 years (January 2013-September 2018) from nine databases examining POM among A/EAs (ages 10-25) in the U.S. Seventy-six articles met our inclusion criteria focusing on POM in the following areas: cross-sectional surveys (n = 60), longitudinal cohort studies (n = 5), objective, non-self-reported data sources (n = 9), and interventions (n = 2). Final charted data elements were organized by methodology and sample, with results tables describing design, sample, interventions (where applicable), outcomes, and limitations. Most studies focused on the epidemiology of POM and risk/protective factors, including demographic (e.g., sex, race), individual (e.g., substance use, mental health), and social (e.g., peer substance use) factors. Despite annual national surveys conducted, longitudinal studies examining markers of initiation and escalation of prescription opioid misuse (e.g., repeated overdoses, time to misuse) are lacking. Importantly, few evidence-based prevention or early intervention programs were identified. Future research should examine longitudinal trajectories of POM, as well as adaptation and implementation of promising prevention approaches.

Personal and Socioeconomic Determinants in Medication-assisted Treatment of Opioid Use Disorder in Adolescents and Young Adults

Opioid use disorder (OUD) is a pediatric and adolescent problem as most young adults (aged <25 years) in treatment programs report initiating use before 25 years of age, and there are lifelong impacts from early substance use necessitating early screening for opioid use and subsequent treatment. Medication-assisted treatment (MAT) is a highly effective intervention for OUD, and there is strong evidence for its use with adolescents; however, most adolescents with OUD are unable to access MAT or remain in MAT long term to achieve substantial recovery. Using case examples drawn from a pediatric and adolescent physician's experiences proving MAT to adolescents and young adults (ages 16-24 years), this article explores the personal and socioeconomic determinants in MAT of OUD in adolescents and young adults and provides suggestions for advocacy areas and resources to improve MAT with this population.

Prescription drug misuse in adolescents and young adults: an emerging issue as a health problem

INTRODUCTION

In recent years, prescription drug misuse has become a common issue among adolescents and young adults in many countries, with, for example, a lifetime prevalence of 12% among individuals aged 12-17 in 2017 in United States.

PURPOSE OF REVIEW

To summarize recently published studies about prescription drug misuse among adolescent and young adults.

RECENT FINDINGS

Prescription drug misuse has many definitions, one being any medication taken in a way other than prescribed, whether related to dosage or manner of usage. Among adolescents, it has a relationship with illicit drug use, decline in academic performance, future delinquency, and mental problems. Individual predisposing factors include identity crisis and role confusion, and there are also environmental influences. Preventive approaches include the use of monitoring systems. Management involves initial assessment and treatment, which largely focuses on behavioural interventions.

SUMMARY

Further understanding of risk and protective factors, co-occurring issues, and treatment can help prevent and reduce the prevalence of prescription drug misuse. Collaboration among government, clinicians, and patients is urged to combat this growing issue.

Prevalence and correlates of nonmedical use of prescription drugs (NMUPD) among Young adults experiencing homelessness in seven cities across the United States

BACKGROUND

Nonmedical use of prescription drugs (NMUPD) is an urgent public health concern facing the United States. Young adults experiencing homelessness (YEH) are at increased risk of NMUPD; however, community estimates of NMUPD among YEH are sparse. This current study sought to understand patterns and correlates of NMUPD in a geographically heterogeneous sample of YEH recruited from seven cities across the United States.

METHODS

From June 2016 to July 2017, 1,426 YEH (aged 18-26) were recruited from seven cities (Houston, Los Angeles, Denver, Phoenix, New York City, St. Louis, San Jose). Participants provided information on substance use, mental health, trauma, and sexual-risk behaviors. Multivariable logistic regression was utilized to assess demographic, psychological, and behavioral correlates of self-reported past-month NMUPD and NMUPD types (i.e., prescription stimulant, sedative, and opioids).

RESULTS

Approximately 20% of participants reported past-month NMUPD. Almost 9% reported misusing prescription opioids, 8.7% misused prescription sedatives, and 6% misused prescription stimulants. Multivariable logistic regressions revealed unmet mental health needs were associated with sedative and stimulant misuse but not opioid misuse. Having suicidal thoughts was associated with opioid misuse but not sedative or stimulant misuse. Although no geographical differences emerged for stimulant and sedative misuse, youth from Denver, Phoenix, and San Jose were more likely to engage in opioid misuse relative to youth in Los Angeles.

CONCLUSIONS

These findings indicate that interventions designed to address NMUPD need to be multifaceted, designed to address other risk behaviors correlated with NMUPD, and target unmet mental health needs.

Substance use off and on school grounds: A California statewide comparison between different groups of homeless students and nonhomeless students

About 1.3 million homeless students attend schools across the US, yet little is known about their substance use patterns, especially substance use on school grounds. The objectives of this study were to examine differences in substance use on and off school grounds between nonsheltered homeless, sheltered homeless, and nonhomeless public school students, and to examine the relationship between homelessness and substance use in school. Data were from a statewide representative sample from the California Healthy Kids Survey collected in 2011-2013, (n = 390,028). Bivariate and multivariate analyses were applied. Findings show that compared to nonhomeless students, homeless students, both sheltered and nonsheltered, reported higher rates of age at first time of use under the age of 10, and recent substance use, for an array of substances, indulging alcohol, cigarettes, marijuana and other illegal drugs. Additionally about 50% of nonsheltered homeless students, and 15% of sheltered homeless students reported having used substances in school in the past 30 days. Results from logistic regressions indicate that homelessness is associated with substance use in school. Particularly, nonsheltered homeless students were 17.41, 12.09, 11.36 and 17.59 times more likely to report smoking cigarettes, drinking alcohol, using marijuana and using other illegal drugs (respectively) in school in the past 30 days, compared to nonhomeless students. Sheltered homeless students were also more likely to use substances in school compared to nonhomeless students, but less likely compared to nonsheltered students. Findings highlight the need to develop differentiated school-based responses to each homeless subgroup and have conceptual, scientific and policy implications.

Appalachian Women's Use of Substance Abuse Treatment: Examining the Behavioral Model for Vulnerable Populations

The Gelberg-Andersen Behavioral Model for Vulnerable Populations was applied to understand vulnerable Appalachian women's (N = 400) utilization of addiction treatment. A secondary data analyses included multiple multivariate analyses. Strongest correlates of treatment utilization included ever injecting drugs (OR = 2.77), limited availability of substance abuse treatment facilities (OR = 2.03), and invalidated violence abuse claims (OR = 2.12). This study contributes theory-driven research to the greater social work addiction literature by confirming that vulnerable domains related to substance abuse treatment utilization warrant unique considerations compared to non-vulnerable domains. Findings also highlight the importance of understanding the unique role that cultural factors play in treatment utilization among Appalachian women. Inferences relevant to clinicians and policymakers are discussed.

A Concept Analysis of Substance Misuse to Inform Contemporary Terminology

Previous diagnostic categories of substance abuse and dependence have given way to the current view that substance use disorders occur on a continuum with a broad range of severity. This current view is featured in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V). In recognizing the role of stigma in preventing persons from seeking substance use treatment, advocates have called attention that particular terminology can fuel such stigma. To mitigate the negative effects of such stigmatizing language, the International Society of Addiction Journal Editors (ISAJE) recommends against using previously-used and possibly pejorative terminology for substance abuse and dependence, unless a particular scientific justification exists. The purpose of this paper is to: (1) present a concept analysis of the term substance misuse and (2) recommend an alternate term for substance misuse that is neither pejorative nor inadvertently stigmatizing: at-risk substance use.

Evaluation of drug use and medication compliance in adolescents admitted to a psychiatric facility from the pediatric emergency department

OBJECTIVES

Knowledge of drug use and medication compliance during mental health evaluation can help guide evaluation and treatment. The objective was to evaluate drug use and medication compliance in a pediatric emergency department (PED) psychiatric population by comparing medical history, standard urine drug screen (EIA), and expanded urine drug screen (HPLC-MS/MS).

METHODS

A prospective cohort study of admitted psychiatric patients ≥13years and ≤18years in a tertiary-care children's hospital psychiatric ED from January 31, 2013 through April 16, 2014.

RESULTS

100 patients in our PED were enrolled. Marijuana was the most commonly admitted and detected substance; 43% had co-ingestions. HPLC-MS/MS revealed 36 additional substance exposures than identified by history. All substances detected by EIA were also detected by HPLC-MS/MS. Combination of history and HPLC-MS/MS revealed the most substances used. HPLC-MS/MS identified antidepressants in 76% of patients prescribed a detectable antidepressant.

CONCLUSION

Marijuana use was greater than nicotine use and was associated with concomitant polysubstance abuse. A combination of history and HPLC-MS/MS was the most thorough in obtaining history of drug use. Almost a quarter of patients did not have their prescribed antidepressant detected by HPLC-MS/MS. A rapid, affordable expanded drug screen should replace the more standard limited drug screen particularly for patients who are refractory to treatment.

Descriptive and injunctive network norms associated with nonmedical use of prescription drugs among homeless youth

BACKGROUND

Nonmedical use of prescription drugs (NMUPD) among youth and young adults is being increasingly recognized as a significant public health problem. Homeless youth in particular are more likely to engage in NMUPD compared to housed youth. Studies suggest that network norms are strongly associated with a range of substance use behaviors. However, evidence regarding the association between network norms and NMUPD is scarce. We sought to understand whether social network norms of NMUPD are associated with engagement in NMUPD among homeless youth.

METHODS

1046 homeless youth were recruited from three drop-in centers in Los Angeles, CA and were interviewed regarding their individual and social network characteristics. Multivariate logistic regression was employed to evaluate the significance of associations between social norms (descriptive and injunctive) and self-reported NMUPD.

RESULTS

Approximately 25% of youth reported past 30-day NMUPD. However, more youth (32.28%) of youth believed that their network members engage in NMUPD, perhaps suggesting some pluralistic ignorance bias. Both descriptive and injunctive norms were associated with self-reported NMUPD among homeless youth. However, these varied by network type, with presence of NMUPD engaged street-based and home-based peers (descriptive norm) increasing the likelihood of NMUPD, while objections from family-members (injunctive norm) decreasing that likelihood.

CONCLUSIONS

Our findings suggest that, like other substance use behaviors, NMUPD is also influenced by youths' perceptions of the behaviors of their social network members. Therefore, prevention and interventions programs designed to influence NMUPD might benefit from taking a social network norms approach.

Nonmedical Use of Prescription Drugs and Sexual Risk Behaviors

BACKGROUND

Substance use is associated with sexual risk behaviors among youth, but little is known about whether nonmedical prescription drug use, an increasingly common behavior, is associated with sexual risk behaviors.

METHODS

Data from the 2011 and 2013 national Youth Risk Behavior Surveys, cross-sectional surveys conducted among nationally representative samples of students in grades 9 to 12 were combined (n = 29,008) to examine the association between ever taking prescription drugs without a doctor's prescription and sexual risk behaviors (ever having sexual intercourse, current sexual activity, lifetime number of sexual partners, condom use, and alcohol or drug use before last sexual intercourse). Using logistic regression models (adjusted for sex, race/ethnicity, grade, ever injection drug use, and use of alcohol, marijuana, heroin, cocaine, methamphetamines, ecstasy, and inhalants), we estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs).

RESULTS

Nonmedical use of prescription drugs (NMUPD) was associated with ever having sexual intercourse (aPR 1.16 [95% CI 1.11-1.22]), being currently sexually active (1.26 [1.20-1.33]), having ≥ 4 lifetime sexual partners (1.45 [1.34-1.57]), drinking alcohol or using drugs before last sexual intercourse (1.32 [1.17-1.48]), and not using a condom at last sexual intercourse (1.14 [1.05-1.23]). As the frequency of NMUPD increased, the association between NMUPD and each of the sexual risk behaviors increased in strength, suggesting a dose-response relationship.

CONCLUSIONS

NMUPD is associated with sexual behaviors that put high school students at risk for sexually transmitted infections. These findings can be used to inform clinical and school-based interventions developed to reduce drug use and sexually transmitted infections.

Prescription drug misuse and suicidal ideation: Findings from the National Survey on Drug Use and Health

OBJECTIVE

Suicide is one of the leading causes of injury-related mortality in the United States and prior research has identified alcohol and other drug use as a major risk factor. In recent years, prescription drug misuse has become a serious public health issue; however, very little research examines the relationship between prescription drug misuse and suicide or suicidal ideation.

METHODS

Using data from the National Survey on Drug Use and Health, the current research examines the relationship between prescription drug misuse and suicidal ideation among adults. Suicidal ideation was measured by asking respondents if they seriously thought about killing themselves in the past 12 months. Prescription drug misuse was defined as use without a prescription or solely for the feeling or experience caused by the drug in the past 12 months. Several multivariable logistic regression models were estimated.

RESULTS

Findings show that respondents who report prescription drug misuse in the past year, specifically pain relievers, are more likely to report that they had seriously though about killing themselves.

CONCLUSIONS

The current research fills an important gap in the literature by examining the relationship between prescription drug misuse and suicidal ideation. Consistent with the extant literature, prescription drug misuse is significantly associated with suicidal ideation among adults.

Diversion of prescription stimulant drugs among 10-18-year-olds

PURPOSE OF REVIEW

Public health concern regarding the nonmedical use of prescription stimulants among youth has generated the need for increased understanding of diversion, which is the illegal sharing and selling of prescription drugs. Although our understanding of nonmedical use of stimulants has increased, the same cannot be said of diversion behavior among youth.

RECENT FINDINGS

The aim of this article is to use data from the National Monitoring of Adolescent Prescription Stimulants Study, which assessed prescription stimulant use among 10-18 years old across 10 US cities to report on prescription stimulant diversion among those who misused those medications. Findings indicate that more than one half (52%) of youth had engaged in one of the three forms of diversion (incoming only, outgoing only and both incoming and outgoing diversion). Engaging in incoming diversion only and both incoming and outgoing diversion increased with age and nonmedical use of prescription stimulants. All forms of diversion increased with marijuana use and among 16-18 years old with a friend's use of prescription stimulant.

SUMMARY

Findings provide an understanding of the subtypes of diversion and risk correlates of youth prescription stimulant diverter's that has value in preventing prescription stimulant diversion.

Prescription Drug Misuse and Sexual Risk Behaviors Among Young Men Who have Sex with Men (YMSM) in Philadelphia

This study examined the relationship between prescription drug misuse and sexual risk behaviors (i.e. unprotected sex, increased number of sex partners) in a sample of young men who have sex with men (YMSM) in Philadelphia. Data come from a cross-sectional study of 18-29 year old YMSM (N = 191) who misused prescription drugs in the past 6 months. Associations were investigated in two regression models: logistic models for unprotected anal intercourse (UAI) and zero-truncated Poisson regression model for number of sex partners. Of 177 participants engaging in anal intercourse in the past 6 months, 57.6 % engaged in UAI. After adjusting for socio-demographic variables and illicit drug use, misuse of prescription pain pills and muscle relaxants remained significantly associated with engaging in receptive UAI. No prescription drug class was associated with a high number of sex partners. This study provides additional evidence that some prescription drugs are associated with sexual risk behaviors among YMSM.

Pet ownership among homeless youth: associations with mental health, service utilization and housing status

As many as 25 % of homeless persons have pets. To our knowledge, pet ownership has not been studied quantitatively with homeless youth. This study examined pet ownership among 398 homeless youth utilizing two Los Angeles drop-in centers. Twenty-three percent of homeless youth had a pet. The majority of pet owners reported that their pets kept them company and made them feel loved; nearly half reported that their pets made it more difficult to stay in a shelter. Pet owners reported fewer symptoms of depression and loneliness than their non-pet owning peers. Pet ownership was associated with decreased utilization of housing and job-finding services, and decreased likelihood of currently staying in a shelter. These findings elucidate many of the positive benefits of pet ownership for homeless youth, but importantly highlight that pet ownership may negatively impact housing options. Housing and other services must be sensitive to the needs of homeless youth with pets.