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Article ; Online: National Institute on Drug Abuse: Dissemination of Scientific Knowledge to Improve Adolescent Health.

Subramaniam, Geetha A / Nolan, Laura / Huntley, Kristen / Corbin, Michelle / Crenshaw, Kenyatta / Mandell, Todd / Linton, Janet / Blackeney, Quandra

The Psychiatric clinics of North America

2023 Volume 46, Issue 4, Page(s) 789–799

Abstract: The wide and effective dissemination of research findings is crucial to the mission of the National Institute on Drug Abuse (NIDA). This article describes NIDA dissemination efforts and resources that are available to inform clinicians, teens, families, ... ...

Abstract	The wide and effective dissemination of research findings is crucial to the mission of the National Institute on Drug Abuse (NIDA). This article describes NIDA dissemination efforts and resources that are available to inform clinicians, teens, families, and educators about youth and substance use. Resources that are available include content addressing facts about youth drug use, trends in use, and stigma, in addition to substance use disorder (SUD) prevention and treatment. Information is provided about resources such as infographics, research-based practice guides, training, educational events, and online videos. How input is solicited to inform dissemination efforts is described and future directions for NIDA's dissemination efforts are outlined.
MeSH term(s)	Adolescent ; United States ; Humans ; National Institute on Drug Abuse (U.S.) ; Adolescent Health ; Substance-Related Disorders/prevention & control
Chemical Substances	N-nitrosoiminodiacetic acid (25081-31-6)
Language	English
Publishing date	2023-09-14
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural
ZDB-ID	431518-2
ISSN	1558-3147 ; 0193-953X
ISSN (online)	1558-3147
ISSN	0193-953X
DOI	10.1016/j.psc.2023.03.009
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Article ; Online: National Institute on Drug Abuse: Dissemination of Scientific Knowledge to Improve Adolescent Health.

Subramaniam, Geetha A / Nolan, Laura / Huntley, Kristen / Corbin, Michelle / Crenshaw, Kenyatta / Mandell, Todd / Linton, Janet / Blackeney, Quandra

Child and adolescent psychiatric clinics of North America

2022 Volume 32, Issue 1, Page(s) 157–167

Abstract	The wide and effective dissemination of research findings is crucial to the mission of the National Institute on Drug Abuse (NIDA). This article describes NIDA dissemination efforts and resources that are available to inform clinicians, teens, families, and educators about youth and substance use. Resources that are available include content addressing facts about youth drug use, trends in use, and stigma, in addition to substance use disorder (SUD) prevention and treatment. Information is provided about resources such as infographics, research-based practice guides, training, educational events, and online videos. How input is solicited to inform dissemination efforts is described and future directions for NIDA's dissemination efforts are outlined.
MeSH term(s)	United States ; Adolescent ; Humans ; National Institute on Drug Abuse (U.S.) ; Adolescent Health ; Social Stigma ; Nitrosamines
Chemical Substances	N-nitrosoiminodiacetic acid (25081-31-6) ; Nitrosamines
Language	English
Publishing date	2022-10-22
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, N.I.H., Intramural
ZDB-ID	1313996-4
ISSN	1558-0490 ; 1056-4993
ISSN (online)	1558-0490
ISSN	1056-4993
DOI	10.1016/j.chc.2022.06.005
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Article ; Online: Substance misuse among adolescents: to screen or not to screen?

Subramaniam, Geetha A / Volkow, Nora D

JAMA pediatrics

2014 Volume 168, Issue 9, Page(s) 798–799

MeSH term(s)	Female ; Humans ; Male ; Mass Screening/instrumentation ; Sickness Impact Profile ; Substance-Related Disorders/classification ; Substance-Related Disorders/diagnosis ; Triage/methods
Language	English
Publishing date	2014-07-28
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	2701223-2
ISSN	2168-6211 ; 2168-6203
ISSN (online)	2168-6211
ISSN	2168-6203
DOI	10.1001/jamapediatrics.2014.958
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Article ; Online: Effects of Training on Use of Stimulant Diversion Prevention Strategies by Pediatric Primary Care Providers: Results from a Cluster-Randomized Trial.

McGuier, Elizabeth A / Kolko, David J / Pedersen, Sarah L / Kipp, Heidi L / Joseph, Heather M / Lindstrom, Rachel A / Bauer, Daniel J / Subramaniam, Geetha A / Molina, Brooke S G

Prevention science : the official journal of the Society for Prevention Research

2022 Volume 23, Issue 7, Page(s) 1299–1307

Abstract: Pediatric primary care is a promising setting for reducing diversion of stimulant medications for ADHD. We tested if training pediatric primary care providers (PCPs) increased use of diversion prevention strategies with adolescents with ADHD. The study ... ...

Abstract	Pediatric primary care is a promising setting for reducing diversion of stimulant medications for ADHD. We tested if training pediatric primary care providers (PCPs) increased use of diversion prevention strategies with adolescents with ADHD. The study was a cluster-randomized trial in 7 pediatric primary care practices. Participants were pediatric PCPs (N = 76) at participating practices. Practices were randomized to a 1-h training in stimulant diversion prevention or treatment-as-usual. At baseline, 6 months, 12 months, and 18 months, PCPs rated how often they used four categories of strategies: patient/family education, medication management/monitoring, assessment of mental health symptoms/functioning, and assessment of risky behaviors. They completed measures of attitudes, implementation climate, knowledge/skill, and resource constraints. Generalized Estimating Equations estimated differences in outcomes by condition. Mediation analyses tested if changes in knowledge/skill mediated training effects on strategy use. PCPs in the intervention condition reported significantly greater use of patient/family education strategies at all follow-up time points. There were no differences between conditions in medication management, assessment of mental health symptoms/functioning, or assessment of risky behaviors. At 6 months, PCPs in the intervention condition reported more positive attitudes toward diversion prevention, stronger implementation climate, greater knowledge/skill, and less resource constraints. Differences in knowledge/skill persisted at 12 months and 18 months. Brief training in stimulant diversion had substantial and enduring effects on PCPs' self-reported knowledge/skill and use of patient/family education strategies to prevent diversion. Training had modest effects on attitudes, implementation climate, and resource constraints and did not change use of strategies related to medication management and assessment of mental health symptoms/functioning and risky behaviors. Changes in knowledge/skill accounted for 49% of the total effect of training on use of patient/family education strategies. Trial registration This trial is registered on ClinicalTrials.gov (NCT03080259). Posted March 15, 2017.
MeSH term(s)	Adolescent ; Child ; Humans ; Mental Disorders ; Mental Health ; Primary Health Care
Language	English
Publishing date	2022-08-11
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	2251270-6
ISSN	1573-6695 ; 1389-4986
ISSN (online)	1573-6695
ISSN	1389-4986
DOI	10.1007/s11121-022-01411-2
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Article ; Online: Prevalence, patterns, and correlates of multiple substance use disorders among adult primary care patients.

John, William S / Zhu, He / Mannelli, Paolo / Schwartz, Robert P / Subramaniam, Geetha A / Wu, Li-Tzy

Drug and alcohol dependence

2018 Volume 187, Page(s) 79–87

Abstract: Background: Addressing multiple substance use disorders (SUDs) in primary care-based screening and intervention may improve SUD treatment access, engagement, and outcomes. To inform such efforts, research is needed on the prevalence and patterns of ... ...

Abstract	Background: Addressing multiple substance use disorders (SUDs) in primary care-based screening and intervention may improve SUD treatment access, engagement, and outcomes. To inform such efforts, research is needed on the prevalence and patterns of multiple SUDs among primary care patients. Methods: Data were analyzed from a sample of 2000 adult (aged ≥ 18) primary care patients recruited for a multisite National Drug Abuse Treatment Clinical Trials Network (CTN) study (CTN-0059). Past-year DSM-5 SUDs (tobacco, alcohol, and drug) were assessed by the modified Composite International Diagnostic Interview. Prevalence and correlates of multiple versus single SUDs were examined. Latent class analysis (LCA) was used to explore patterns of multiple SUDs. Results: Multiple SUDs were found among the majority of participants with SUD for alcohol, cannabis, prescription opioids, cocaine, and heroin. Participants who were male, ages 26-34, less educated, and unemployed had increased odds of multiple SUDs compared to one SUD. Having multiple SUDs was associated with greater severity of tobacco or alcohol use disorder. LCA of the sample identified three classes: class 1 (83.7%) exhibited low prevalence of all SUDs; class 2 (12.0%) had high-moderate prevalence of SUDs for tobacco, alcohol, and cannabis; class 3 (4.3%) showed high prevalence of SUD for tobacco, opioids, and cocaine. LCA-defined classes were distinguished by sex, age, race, education, and employment status. Conclusions: Findings suggest that primary care physicians should be aware of multiple SUDs when planning treatment, especially among adults who are male, younger, less educated, or unemployed. Interventions that target multiple SUDs warrant future investigation.
MeSH term(s)	Adolescent ; Adult ; Alcoholism/epidemiology ; Comorbidity ; Female ; Humans ; Male ; Middle Aged ; Prevalence ; Primary Health Care/statistics & numerical data ; Substance-Related Disorders/epidemiology ; Young Adult
Language	English
Publishing date	2018-03-27
Publishing country	Ireland
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2018.01.035
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Article ; Online: Use of Stimulant Diversion Prevention Strategies in Pediatric Primary Care and Associations With Provider Characteristics.

McGuier, Elizabeth A / Kolko, David J / Joseph, Heather M / Kipp, Heidi L / Lindstrom, Rachel A / Pedersen, Sarah L / Subramaniam, Geetha A / Molina, Brooke S G

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

2021 Volume 68, Issue 4, Page(s) 808–815

Abstract: Purpose: Diversion of stimulant medications for ADHD is a prevalent problem. Pediatric primary care providers (PCPs) are well-positioned to reduce diversion risk among adolescents prescribed stimulants, but little is known about their use of prevention ... ...

Abstract	Purpose: Diversion of stimulant medications for ADHD is a prevalent problem. Pediatric primary care providers (PCPs) are well-positioned to reduce diversion risk among adolescents prescribed stimulants, but little is known about their use of prevention strategies. The objectives of this study were to describe the frequency with which pediatric PCPs use diversion prevention strategies and examine potential determinants (facilitators and barriers) of strategy use. Methods: Participants were pediatric PCPs (N = 76) participating in a randomized controlled trial of stimulant diversion prevention strategies. At baseline, before randomization, PCPs rated the frequency with which they used specific strategies in each of four categories: patient/family education, medication management/monitoring, assessment of mental health symptoms/functioning, and assessment of risky behaviors. They completed measures of attitudes toward diversion prevention, subjective norms (i.e., implementation climate), and perceived behavioral control (i.e., knowledge/skill, resource constraints). Associations between determinants and strategy use were tested with correlational and regression analyses. Results: PCPs used strategies for assessing mental health symptoms/functioning most frequently and patient/family education strategies least frequently. Attitudes about the effectiveness of diversion prevention, implementation climate, knowledge/skill, and resource constraints were positively correlated with the use of at least one category of strategies. In regression analysis, PCP knowledge/skill was positively associated with patient/family education, medication management, and risk assessment strategies. Conclusions: Findings suggest that improving knowledge and skill may increase the use of diversion prevention strategies by PCPs. Identifying provider-level determinants of strategy use informs implementation efforts in pediatric primary care and can facilitate efforts to prevent stimulant diversion among adolescents.
MeSH term(s)	Adolescent ; Attention Deficit Disorder with Hyperactivity/drug therapy ; Central Nervous System Stimulants/therapeutic use ; Child ; Health Personnel ; Humans ; Mental Health ; Primary Health Care
Chemical Substances	Central Nervous System Stimulants
Language	English
Publishing date	2021-01-11
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	1063374-1
ISSN	1879-1972 ; 1054-139X
ISSN (online)	1879-1972
ISSN	1054-139X
DOI	10.1016/j.jadohealth.2020.12.006
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Article ; Online: Adolescents Treated for Attention-Deficit/Hyperactivity Disorder in Pediatric Primary Care: Characterizing Risk for Stimulant Diversion.

Molina, Brooke S G / Joseph, Heather M / Kipp, Heidi L / Lindstrom, Rachel A / Pedersen, Sarah L / Kolko, David J / Bauer, Daniel J / Subramaniam, Geetha A

Journal of developmental and behavioral pediatrics : JDBP

2021 Volume 42, Issue 7, Page(s) 540–552

Abstract: Objective: To describe the clinical and psychosocial characteristics, and their hypothesized interrelations, as it pertains to risk for stimulant diversion (sharing, selling, or trading) for adolescents in pediatric primary care treatment for attention- ... ...

Abstract	Objective: To describe the clinical and psychosocial characteristics, and their hypothesized interrelations, as it pertains to risk for stimulant diversion (sharing, selling, or trading) for adolescents in pediatric primary care treatment for attention-deficit/hyperactivity disorder. Methods: Baseline data for 341 adolescents in a cluster-randomized controlled trial of stimulant diversion prevention in pediatric primary care (NCT_03080259) were used to (1) characterize diversion and newly measured risk factors, (2) examine their associations with age and sex, and (3) test whether associations among risk factors were consistent with model-implied predictions. Data were collected through multi-informant electronic surveys from adolescents and parents. Results: Diversion was rare (1%) in this sample (Mage = 15, SD = 1.5, 74% male participants). Older age was associated with being approached to divert (r = 0.25, p < 0.001) and higher risk on variables pertinent to stimulant treatment, such as treatment disclosure (r = 0.12, p < 0.05), tolerance for stimulant misuse and diversion (r = 0.17, p < 0.05), and peer norms favorable to stimulant misuse and diversion (r values = 0.15-0.34, p < 0.001). Sex differences were minimal. Variables from our conceptual model and specific to stimulants (e.g., perceived likelihood of negative consequences from diversion and schoolmate stimulant misuse/diversion) were related in multivariable regressions to hypothesized immediate precursors of diversion (e.g., diversion intentions). Conclusion: Although diversion was rare for these primary care-treated adolescents, risk levels appear to be higher for older adolescents. Prevention may be most effective by capitalizing on current psychosocial strengths and discussing stimulant-specific attitudes, behaviors, and social norms before vulnerability to diversion increases in the final years of high school and into college.
MeSH term(s)	Adolescent ; Aged ; Attention Deficit Disorder with Hyperactivity/drug therapy ; Central Nervous System Stimulants/adverse effects ; Child ; Female ; Humans ; Male ; Prescription Drug Diversion ; Primary Health Care ; Surveys and Questionnaires
Chemical Substances	Central Nervous System Stimulants
Language	English
Publishing date	2021-04-21
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	603379-9
ISSN	1536-7312 ; 0196-206X
ISSN (online)	1536-7312
ISSN	0196-206X
DOI	10.1097/DBP.0000000000000923
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Article ; Online: Subthreshold opioid use disorder prevention (STOP) trial: a cluster randomized clinical trial: study design and methods.

Liebschutz, Jane M / Subramaniam, Geetha A / Stone, Rebecca / Appleton, Noa / Gelberg, Lillian / Lovejoy, Travis I / Bunting, Amanda M / Cleland, Charles M / Lasser, Karen E / Beers, Donna / Abrams, Catherine / McCormack, Jennifer / Potter, Gail E / Case, Ashley / Revoredo, Leslie / Jelstrom, Eve M / Kline, Margaret M / Wu, Li-Tzy / McNeely, Jennifer

Addiction science & clinical practice

2023 Volume 18, Issue 1, Page(s) 70

Abstract: Background: Preventing progression to moderate or severe opioid use disorder (OUD) among people who exhibit risky opioid use behavior that does not meet criteria for treatment with opioid agonists or antagonists (subthreshold OUD) is poorly understood. ... ...

Abstract	Background: Preventing progression to moderate or severe opioid use disorder (OUD) among people who exhibit risky opioid use behavior that does not meet criteria for treatment with opioid agonists or antagonists (subthreshold OUD) is poorly understood. The Subthreshold Opioid Use Disorder Prevention (STOP) Trial is designed to study the efficacy of a collaborative care intervention to reduce risky opioid use and to prevent progression to moderate or severe OUD in adult primary care patients with subthreshold OUD. Methods: The STOP trial is a cluster randomized controlled trial, randomized at the PCP level, conducted in 5 distinct geographic sites. STOP tests the efficacy of the STOP intervention in comparison to enhanced usual care (EUC) in adult primary care patients with risky opioid use that does not meet criteria for moderate-severe OUD. The STOP intervention consists of (1) a practice-embedded nurse care manager (NCM) who provides patient participant education and supports primary care providers (PCPs) in engaging and monitoring patient-participants; (2) brief advice, delivered to patient participants by their PCP and/or prerecorded video message, about health risks of opioid misuse; and (3) up to 6 sessions of telephone health coaching to motivate and support behavior change. EUC consists of primary care treatment as usual, plus printed overdose prevention educational materials and an educational video on cancer screening. The primary outcome measure is self-reported number of days of risky (illicit or nonmedical) opioid use over 180 days, assessed monthly via text message using items from the Addiction Severity Index and the Current Opioid Misuse Measure. Secondary outcomes assess other substance use, mental health, quality of life, and healthcare utilization as well as PCP prescribing and monitoring behaviors. A mixed effects negative binomial model with a log link will be fit to estimate the difference in means between treatment and control groups using an intent-to-treat population. Discussion: Given a growing interest in interventions for the management of patients with risky opioid use, and the need for primary care-based interventions, this study potentially offers a blueprint for a feasible and effective approach to improving outcomes in this population. Trial registration: Clinicaltrials.gov, identifier NCT04218201, January 6, 2020.
MeSH term(s)	Adult ; Humans ; Analgesics, Opioid/adverse effects ; Quality of Life ; Opioid-Related Disorders/drug therapy ; Research Design ; Patient Acceptance of Health Care
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2023-11-18
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2492632-2
ISSN	1940-0640 ; 1940-0640
ISSN (online)	1940-0640
ISSN	1940-0640
DOI	10.1186/s13722-023-00424-8
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Article ; Online: Clinical characteristics of treatment-seeking prescription opioid vs. heroin-using adolescents with opioid use disorder.

Subramaniam, Geetha A / Stitzer, Maxine A

Drug and alcohol dependence

2008 Volume 101, Issue 1-2, Page(s) 13–19

Abstract: Objectives: To compare the clinical characteristics of treatment-seeking prescription opioid-using adolescents with DSM-IV opioid use disorder (OUD) to those with heroin-using OUD adolescents.: Method: We analyzed the data on OUD adolescents (94, ... ...

Abstract	Objectives: To compare the clinical characteristics of treatment-seeking prescription opioid-using adolescents with DSM-IV opioid use disorder (OUD) to those with heroin-using OUD adolescents. Method: We analyzed the data on OUD adolescents (94, ages 14-18 years) extracted from the parent study dataset comparing clinical characteristics of treatment-seeking OUD to non-OUD adolescents from a adolescent substance abuse treatment program in Baltimore, MD. The sample consisted of 41 non-heroin prescription opioid-using and 53 heroin-using OUD adolescents who were assessed cross-sectionally using standardized interviews and self-reports. Chi-square and t-tests were performed to determine group differences on demographic, substance use, psychiatric and HIV-risk behaviors. Results: Both groups were older (mean 17 years), predominantly Caucasian, and had a suburban residence; they had high rates of co-occurring psychiatric disorders (83%) and they reported moderately high depression symptoms. The heroin-using sample was more likely to have dropped out of school, be dependent on opioids and inject drugs using needles. The prescription opioid-using OUD youth were more likely to meet criteria for multiple SUDs (including prescription sedatives and psychostimulants), current ADHD and report selling drugs; and more likely to be court ordered to current treatment and report prior psychiatric treatment. Conclusions: Both groups of treatment-seeking OUD adolescents had multiple comorbidities but there were substantial differences between prescription opioid-users and heroin-users. These differences may suggest different prognoses and treatment implications. Future research may shed light on the factors leading to differences in choice of opioids and their impact on treatment outcomes; and assess the role of agonist assisted treatments and integrated psychiatric care.
MeSH term(s)	Adolescent ; Age of Onset ; Crime/statistics & numerical data ; Diagnosis, Dual (Psychiatry) ; Female ; Heroin Dependence/psychology ; Heroin Dependence/rehabilitation ; Humans ; Male ; Mental Disorders/complications ; Mental Disorders/psychology ; Opioid-Related Disorders/psychology ; Opioid-Related Disorders/rehabilitation ; Patient Acceptance of Health Care/psychology ; Prescription Drugs ; Psychiatric Status Rating Scales ; Risk Factors ; Socioeconomic Factors ; Substance Abuse Treatment Centers ; Substance Abuse, Intravenous ; Unsafe Sex
Chemical Substances	Prescription Drugs
Language	English
Publishing date	2008-12-09
Publishing country	Ireland
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2008.10.015
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Article ; Online: Prevalence and patterns of opioid misuse and opioid use disorder among primary care patients who use tobacco.

John, William S / Zhu, He / Mannelli, Paolo / Subramaniam, Geetha A / Schwartz, Robert P / McNeely, Jennifer / Wu, Li-Tzy

Drug and alcohol dependence

2018 Volume 194, Page(s) 468–475

Abstract: Background: Current data suggest that opioid misuse or opioid use disorder (OUD) may be over represented among tobacco users. However, this association remains understudied in primary care settings. A better understanding of the extent of heterogeneity ... ...

Abstract	Background: Current data suggest that opioid misuse or opioid use disorder (OUD) may be over represented among tobacco users. However, this association remains understudied in primary care settings. A better understanding of the extent of heterogeneity in opioid misuse among primary care patients who use tobacco may have implications for improved primary care-based screening, prevention, and intervention approaches. Methods: Data were derived from a sample of 2000 adult (aged ≥18) primary care patients across 5 distinct clinics. Among past-year tobacco users (n = 882), we assessed the prevalence of opioid misuse and OUD by sociodemographic characteristics and past-year polysubstance use. Latent class analysis (LCA) was used to identify heterogeneous subgroups of tobacco users according to past-year polysubstance use patterns. Multinomial logistic regression was used to examine variables associated with LCA-defined class membership. Results: Past-year tobacco use was reported by >84% of participants who reported past-year opioid misuse or OUD. Among those reporting past-year tobacco use, the prevalence of past-year opioid misuse and OUD was 14.0% and 9.5%, respectively. The prevalence of opioid misuse or OUD was highest among tobacco users who were male or unemployed. Three LCA-defined classes among tobacco users were identified including a tobacco-minimal drug use group (78.0%), a tobacco-cannabis use group (10.1%), and a tobacco-opioid/polydrug use group (11.9%). Class membership differed by sociodemographic characteristics. Conclusions: Results from this study support the benefit of more comprehensive assessment of and/or monitoring for opioid misuse among primary care patients who use tobacco, particularly for those who are male, unemployed, or polydrug users.
MeSH term(s)	Adolescent ; Adult ; Female ; Humans ; Male ; Marijuana Smoking/epidemiology ; Middle Aged ; Opioid-Related Disorders/epidemiology ; Prevalence ; Primary Health Care ; Tobacco Use/epidemiology ; Young Adult
Language	English
Publishing date	2018-11-26
Publishing country	Ireland
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2018.11.011
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