Fentanyl-Related Substance Use Patterns, Morbidity, and Mortality Among Adolescents and Young Adults: Implications for Behavioral Health Services Research.

This commentary discusses best practices for responding to fentanyl-related overdose deaths in adolescents and young adults, and it outlines the current state of knowledge about them. Various types of approaches to fentanyl-related overdoses in this age group may need to be developed based on the different risk factors that are emerging from the existing data. We describe the National Institute on Drug Abuse (NIDA) behavioral health services research priorities connected with fentanyl-related overdoses in youth. We highlight a key target for intervention and discuss research opportunities related to early intervention with youth with identifiable risk factors. NIDA's research agenda is a means of assisting communities that experience fentanyl-related overdoses by providing scientific information that can be translated into clear recommendations for public action.

Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children.

OBJECTIVES: To use the latest data to estimate the prevalence and correlates of currently diagnosed depression, anxiety problems, and behavioral or conduct problems among children, and the receipt of related mental health treatment. STUDY DESIGN: We analyzed data from the 2016 National Survey of Children's Health (NSCH) to report nationally representative prevalence estimates of each condition among children aged 3-17 years and receipt of treatment by a mental health professional. Parents/caregivers reported whether their children had ever been diagnosed with each of the 3 conditions and whether they currently have the condition. Bivariate analyses were used to examine the prevalence of conditions and treatment according to sociodemographic and health-related characteristics. The independent associations of these characteristics with both the current disorder and utilization of treatment were assessed using multivariable logistic regression. RESULTS: Among children aged 3-17 years, 7.1% had current anxiety problems, 7.4% had a current behavioral/conduct problem, and 3.2% had current depression. The prevalence of each disorder was higher with older age and poorer child health or parent/caregiver mental/emotional health; condition-specific variations were observed in the association between other characteristics and the likelihood of disorder. Nearly 80% of those with depression received treatment in the previous year, compared with 59.3% of those with anxiety problems and 53.5% of those with behavioral/conduct problems. Model-adjusted effects indicated that condition severity and presence of a comorbid mental disorder were associated with treatment receipt. CONCLUSIONS: The latest nationally representative data from the NSCH show that depression, anxiety, and behavioral/conduct problems are prevalent among US children and adolescents. Treatment gaps remain, particularly for anxiety and behavioral/conduct problems.

Age-related trends in psychotropic medication use among very young children in foster care.

OBJECTIVES: The specific objectives were to investigate changes in the prevalence of psychotropic medication use for each year increase in age from three to six years old among children in foster care and to examine time-varying odds of longer duration of use by each year of age. METHODS: A retrospective analysis of data on mental health and pharmacy services was conducted for 1,491 children age six and younger who were in foster care in 2010 and had at least 365 days in foster care during 2009-2011. A total of 178 children received at least one psychotropic medication from 2009 through 2011. Psychotropic prevalence and average days of use were calculated for each therapeutic class. Longitudinal regression models assessed the time-varying relationship between year of age and duration of use, controlling for demographic and clinical covariates. RESULTS: Approximately 12% of children age six and younger in foster care for 365 days or more received at least one psychotropic medication over the three-year study period. Prevalence of ADHD medication and antipsychotic medication and duration increased with each year of age (p<.001). In adjusted longitudinal models, each year increase in age was associated with a nearly twofold higher likelihood of longer duration of antipsychotic and ADHD medication use. CONCLUSIONS: Young children who initiated antipsychotic and ADHD medications before the age of six continued to receive them for longer periods of time. There is a critical need for long-term studies to evaluate the effect of chronic exposure on children's health and well-being.

A phenomenological case study of communication between clinicians about attention-deficit/hyperactivity disorder assessment.

INTRODUCTION: Communication between clinicians related to attention-deficit/hyperactivity disorder (ADHD) assessment is challenging because it involves a number of individuals. While the communication process might be more efficient if these individuals worked together, research on ADHD-specific collaborative care models is scarce. The purpose of this qualitative study was to investigate the parties with whom prescribers communicate and how they collaborate. METHODS: Providers were interviewed, and the data were analyzed using a phenomenological case study approach. RESULTS: The results suggested that there were communication breakdowns between providers and teachers that hindered the assessment process. DISCUSSION: Communication related to ADHD assessment may be more complex than theoretical models may conceptualize.

Olfactory transport: a direct route of delivery of inhaled manganese phosphate to the rat brain.

Experiments examining the dosimetry of inhaled manganese generally focus on pulmonary deposition and subsequent delivery of manganese in arterial blood to the brain. Growing evidence suggests that nasal deposition and transport along olfactory neurons represents another route by which inhaled manganese is delivered to certain regions of the rat brain. The purpose of this study was to evaluate the olfactory uptake and direct brain delivery of inhaled manganese phosphate ((54)MnHPO(4)). Male, 8-wk-old, CD rats with either both nostrils patent or the right nostril occluded underwent a single, 90-min, nose-only exposure to a (54)MnHPO(4) aerosol (0.39 mg (54)Mn/m(3); MMAD 1.68 microm, sigma(g) 1.42). The left and right sides of the nose, olfactory pathway, striatum, cerebellum, and rest of the brain were evaluated immediately after the end of the (54)MnHPO(4) exposure and at 1, 2, 4, 8, and 21 d postexposure with gamma spectrometry and autoradiography. Rats with two patent nostrils had equivalent (54)Mn concentrations on both sides of the nose, olfactory bulb, and striatum, while asymmetrical (54)Mn delivery occurred in rats with one occluded nostril. High levels of (54)Mn activity were observed in the olfactory bulb and tubercle on the same side (i.e., ipsilateral) to the open nostril within 1-2 d following (54)MnHPO(4) exposure, while brain and nose samples on the side ipsilateral to the nostril occlusion had negligible levels of (54)Mn activity. Our results demonstrate that the olfactory route contributes to (54)Mn delivery to the rat olfactory bulb and tubercle. However, this pathway does not significantly contribute to striatal (54)Mn concentrations following a single, short-term inhalation exposure to (54)MnHPO(4).