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A dog’s pain medication, a grandparent’s pill organizer, even a discarded tissue: Rutgers Health research reveals they’re all potential sources of opioid poisoning for young children.

Researchers at the New Jersey Poison Control Center examined 230 cases of opioid exposure in children ages 1 month to 6 years over a five-year period. Their findings in the Journal of Pediatrics show how children access these dangerous drugs.

“We’re seeing this in our clinical practice,” said Diane Calello, the medical director of the poison control center and senior author of the study. “I’ve seen too many kids in my practice at University Hospital who have gotten severely poisoned because they got opioids in their house.”

An overwhelming majority of exposures (97 percent) were unintentional. More than 91 percent occurred in the child’s home, and 84.3 percent resulted in the child being admitted to a health care facility.

While many cases involved a child accessing a parent’s medication, the study uncovered several unexpected sources of exposure. Grandparents’ medications were implicated in 17.4 percent of cases, highlighting what the researchers described as an often-overlooked risk factor: exposure to older adults who may not be as vigilant as parents about securing their medications.

Another significant risk came from pet medications, which were involved in 4.3 percent of cases. Children sometimes accessed these opioids directly and sometimes accessed pet medication that had been mixed with food, such as peanut butter, and then left out.

Children ages 2 and under accounted for 80 percent of all exposures. Kids in this age group face particularly high risk because of their exploratory behavior and inability to distinguish between safe and dangerous substances.

The study drew data from reports to the New Jersey Poison Control Center between January 2018 and December 2022. Researchers manually extracted and analyzed information from the center’s database, focusing on single opioid exposures in young children.

While prescription opioid pills were the most common source of danger, the study uncovered other scenarios. Children accessed used fentanyl patches, illicit drug paraphernalia and even opioid residue left on discarded items such as tissue paper and cotton balls.

The study highlights the importance of proper medication storage and disposal, Calello said.

“One opioid pill could actually kill a 2-year-old,” she said. “And yet, a parent who may take that opioid pill every day may not realize that even though it’s very familiar to them, it is deadly.”

The study authors said there is a need for more comprehensive education about the dangers of opioids in the home. Calello suggested it should include grandparents and anyone who might bring medications into a home where children are present.

One potential solution is increasing access for parents and caregivers to naloxone, a medication that can reverse opioid overdoses, Calello said.

“I’ve seen several cases of young children where I thought that if this mom or dad had naloxone with them, they could have given it, and this child may have had a better outcome,” she said.

Looking forward, the study team is preparing to publish data on how children nationwide are exposed to opioids. Those figures show more pediatric exposures to illicit opioids and medications for treating opioid addiction.

Calello added that she hopes to study the effects of distributing naloxone more widely to parents.

“That would be a good next step,” she said. “It could make a big difference.”

Newswise — Behavioral health professionals at Rutgers will work with the state to increase and improve the delivery of mental health and substance use services to the underserved communities of Newark and Elizabeth under a $4.5 million federal grant.

The New Jersey Division of Mental Health and Addiction Services has received the funding and will work with the Rutgers University Behavioral Health Care’s Center for Integrated Care (CIC).

The center will assist in a plan to bring more behavioral care providers directly into primary care offices. Those in the industry refer to this particular integrated care system as the  Collaborative Care Model. The idea is to assess the patient and connect him with behavioral health and psychiatry immediately without the need for referrals. The approach would save patients time, increase their access to care, ease the workload of the primary care doctors and save medical costs.

“This is an exciting partnership with the state that allows us to not only improve treatment and treatment access in medically underserved areas, but to also have the opportunity to impact state planning and advance collaborative care across state health programs,” said Holly Lister, a psychologist and program manager for the center.

The project is designed to increase the identification and treatment of people with behavioral health disorders, improve engagement and retention in care and use measurement-based care to improve the treatment of serious mental illness, child and adolescent emotional disturbance and co-occurring physical health conditions – directly in primary care.

This is the fourth grant to assist the CIC in increasing integrated behavioral health services and promote education about integrated care models throughout New Jersey.

The funding will also include educating healthcare providers and the public about the collaborative care approach to providing care.

Newswise — Whether they’re using it for recreational or medical reasons, a sizable percentage of people in their 50s and older have smoked, eaten, drunk or applied to their skin at least one form of cannabis in the past year, a new poll shows.

In all, 21% of people age 50 and older said they used a form of cannabis that contains the psychoactive compound THC at least once in the past year, according to new findings from the University of Michigan National Poll on Healthy Aging. The poll report focuses on use of cannabis products with psychoactive amounts of THC, not CBD-only products.

More than half of those who used a cannabis product did so frequently: 12% of adults aged 50 and older said they did so at least once a month. Those aged 50 to 64, and those who are in fair or poor physical health, or in lower income households were more likely to report using cannabis at least monthly. 

As for the reasons older adults use cannabis, many cited sleep (68%), help with pain (63%) or mental health (53%), and/or to relax or feel good (81%).

The poll also reveals potential risky behaviors related to cannabis use. 

Among those who use cannabis at least once a year, 20% said they had driven a vehicle within two hours of consumption; many experts recommend waiting two or even three times that long. And the rate of such driving was even higher – 27% – among those who use cannabis at least once a month. 

In addition, nearly half of older adults who use cannabis products at least monthly had not discussed their use with their health care provider. And more than 20% reported at least one sign of potential dependence on cannabis.

The poll is based at the U-M Institute for Healthcare Policy and Innovation, and supported by AARP and Michigan Medicine, U-M’s academic medical center. 

Erin E. Bonar, Ph.D., a U-M addiction psychologist who worked with the poll team on the report, says the findings suggest a need for action at the policy, clinical and community levels to identify those who may need treatment for cannabis addiction and to discourage driving or other risky behaviors after consumption. 

“With some form of cannabis use now legalized in 38 states and on the ballot this November in several others, and the federal rescheduling process under way, cannabis use is likely to grow,” she said. “But as this poll shows, it is not risk-free, and more attention is needed to identify and reduce those risks.”

Bonar is a member of IHPI, the U-M Addiction Center and the U-M Injury Prevention Center as well as a professor in the Medical School Department of Psychiatry. 

In addition to the national poll report, the team compiled data for Michigan adults age 50 and older compared with those in other states; a summary is available at https://michmed.org/JYJer and an interactive data visualization is available at https://michmed.org/4e2KW. 

Cannabis potency and addiction: Views of all older adults

The poll team also asked all older adults – including those who don’t use cannabis – about their views of cannabis. The results suggest a need for more public awareness efforts, Bonar says. 

People in their 50s and beyond may have familiarity with cannabis from decades ago, whether through direct use or indirect knowledge during a time when it was illegal for any use in all states. Because of this, the poll team asked whether they believe cannabis is stronger today than it was 20 to 30 years ago.

The vast majority – 79% — of older adults said they thought this was true. But Bonar notes that this means 21% aren’t currently aware of the major increases in THC levels found in cannabis available today, compared with levels in the 1990s and before. 

Meanwhile, 72% of all older adults said they believe people can become addicted to cannabis. But, Bonar notes, this means more than a quarter of older adults aren’t currently aware that research has shown conclusively that cannabis addiction is real and can affect someone’s life and health just as addiction to other substances can. 

Importance of discussing with health care providers 

For those who use cannabis, especially those who use it often, poll director Jeffrey Kullgren, M.D., M.P.H., M.S. says the poll findings show the importance of communicating with their health care provider about their use. 

In all, 56% of those who use cannabis with THC at least monthly said they had spoken with their regular health care provider about their use. Most of them said they had brought the topic up. 

Talking openly with a provider about use could help identify risky drug interactions, and spot those experiencing signs of cannabis dependence or addiction. 

In all, 22% of those who use cannabis at least monthly said in the past year they had had to use more cannabis to feel the effect they wanted, and 21% said using the same amount of cannabis had less of an effect on them than it had before, while 17% said they had increased the amount or frequency of their cannabis use. Another sign of potential addiction – strong desires or cravings to use cannabis with THC – was reported by 13% of those who use cannabis at least monthly.

“Even if your doctor, nurse practitioner or pharmacist doesn’t ask if you’re using cannabis products, it’s important to offer this information, no matter whether you’re using it to address a physical or mental health concern, or simply for pleasure,” says Kullgren, a primary care physician at the VA Ann Arbor Healthcare System and associate professor of internal medicine at U-M. “Many prescription medications and over-the-counter drugs, as well as alcohol, can interact with cannabis and cause unexpected or unwanted effects. And there are only a few conditions where we have good evidence of a medical benefit from cannabis, though this could change with time.”

The current process at the federal level to change how cannabis is listed on the schedule of controlled substances may free more researchers to do studies of cannabis-derived products in clinical trials involving human volunteers. Right now, such research is very limited because of federal restrictions. 

The poll report is based on findings from a nationally representative survey conducted by NORC at the University of Chicago for IHPI and administered online and via phone in February and March 2024 among 3,379 adults ages 50 and older. The sample was subsequently weighted to reflect the U.S. and Michigan populations. Read past National Poll on Healthy Aging reports and about the poll methodology.

Broadcast quality interview and B-roll footage are available at https://michmed.org/NrGeW 

BYLINE: Tracy DeStazio

Newswise — Since the COVID-19 pandemic, rates of chronic absenteeism have nearly doubled across the nation for students in kindergarten through grade 12.

This increase was tied to the mode of instruction during the early years of the pandemic. In particular, schools that employed virtual learning as the primary teaching mode during the 2020-21 school year experienced a greater increase in chronic absenteeism in the following year. That increase was significantly greater in school districts with higher levels of poverty, according to new research from the University of Notre Dame.

William Evans, the Keough-Hesburgh Professor of Economics and co-founder of Notre Dame’s Wilson Sheehan Lab for Economic Opportunities, co-authored the study with current undergraduate student Kathryn Muchnick and 2024 graduate Olivia Rosenlund. Their work was recently published in the scientific journal JAMA Network Open.

The study analyzed data for two years from more than 11,000 school districts across the United States and found that chronic absenteeism rates increased from 16 percent in 2018-19 to nearly 30 percent in the 2021-22 school year. Students whose schools had full virtual instruction during the pandemic had chronic absenteeism rates that were nearly 7 percentage points higher than those schools that were fully in person, according to the research.

A student is considered chronically absent if he or she misses at least 10 percent of the instructional days in any given school year. That equates to more than three weeks of absences during a 180-day academic year.

As reported in the study, chronic absenteeism has been shown to lead to lower test scores, reduced social and educational interactions, lower rates of high school graduation and increased substance use. The increase in chronic absenteeism began to occur as public schools in the U.S. were attempting to return to pre-pandemic modes of in-person teaching.

Previous studies have indicated that moving away from in-person instruction during the 2020-21 school year to online teaching methods reduced student achievement and educational development, adversely affected children’s mental well-being and decreased school enrollment.

“We’ve learned a lot from the pandemic,” Evans said, “and a lot of work has gone into researching what effects virtual learning has had on students. It’s really difficult when you disrupt their educational experience by going remote.”

Both of Evans’ co-authors were high school students during the pandemic, giving them a uniquely personal perspective on the study’s results. Rosenlund said that when she entered the end of her senior year with fully virtual classes, she and her classmates “definitely had lower motivation to learn during that time compared to when class was fully in person.”

Muchnick added, “The shift in student motivation after online learning [back to in-person] was palpable.”

The research also indicated that chronic absenteeism rates hit at-risk students and school districts with the highest levels of poverty the hardest. Those school districts saw chronic absenteeism soar more than 10 percentage points higher among students who had participated in fully remote instruction, versus in-person learning.

“There is growing evidence that those in the most precarious situations were the ones that were really hurt the most by virtual instruction,” Evans said. “The districts with higher levels of poverty had higher rates of chronic absenteeism already, and they were much more aggressive at using virtual learning during COVID. So you took a vulnerable population, used this method of delivery for educational instruction, and the outcomes for these children are substantially worse.”

Households with lower incomes or fewer resources were less likely to have reliable or high-speed internet service and had far less access to quality computers or technology, making for a less-than-ideal virtual learning environment. “It was pretty detrimental for those kids who were most at risk in the first place,” Evans added, “and now they’ve been pushed further behind as a result of these policies.”

Although the study did not specifically explore the reasons behind the drop in school attendance, it did offer several possible explanations. First, roughly 10 to 20 percent of students were experiencing post-COVID-19 symptoms and may have elected not to go to school for medical and health reasons. Second, there was a corresponding increase in teacher absences and substitute teacher shortages that made students less compelled to go to school. Third, a greater occurrence of mental health issues, which is often coupled with an increased preoccupation with social media, may have kept students at home. Finally, following the pandemic, parents appear to be more willing to allow their children to miss school for a variety of reasons.

With the worst of the pandemic behind us, many parents, school teachers and administrators believe that virtual instruction is here to stay and will continue as a major component of K-12 education, potentially being used as a substitute for in-person teaching under certain circumstances, such as snow days.

“It’s going to be really difficult to put the genie back in the bottle in this context,” Evans said.

Finding a balance of how to use virtual learning in a way that does not negatively impact the students’ overall educational experience will be crucial, according to the researchers.

Rosenlund added, “It’s disheartening that students are still suffering from the negative effects of online learning. I hope that we can consider its implications more carefully going forward.”

The researchers suggest that educators and policymakers examine the evidence when establishing policies and practices related to online learning, particularly for those communities supporting at-risk students, in order to achieve equitable outcomes for all students.

“I think we need to take a more holistic approach in thinking about how to deal with these pandemics in the future,” Evans said.

Contact: Tracy DeStazio, associate director of media relations, 574-631-9958 or [email protected]

Newswise — Certain concepts have a demonstrated basis for aiding recovery from dangerous alcohol or substance use, according to an analysis of scientific literature since 1990. Self-efficacy (a belief in one’s ability to achieve a goal), social support, and managing cravings are among the treatment elements best supported by evidence. Effective treatment for alcohol use disorder (AUD) and other substance use disorders (SUDs) depends on understanding how human behaviors change and incorporating that knowledge into clinical practice. An ongoing research effort continues to investigate varying treatment approaches and how they relate to recovery outcomes, but those findings have not been well synthesized into a useful format. For the new review published in Alcohol: Clinical & Experimental Research, researchers from around the USA reviewed published studies, identified the treatment elements best supported by data, and evaluated their potential as key factors in behavior change. The researchers drew on existing study design criteria for validating conclusions about treatment elements.

The researchers explored reviews of studies published between 2008 and 2023 involving AUD and SUD treatments and the effects on substance use and related outcomes in adults. Three constructs involved in treatment were the most well-supported by data from 11 studies: self-efficacy, social support, and craving (coping skills, also well-supported, did not suit the current review process). They then reviewed 48 studies published between 1990 and 2023 that focused on one or more of these three concepts in adults’ recovery, and that met rigorous methodology standards. The 48 studies used varied research designs, participant samples, and contexts.

The analyzed studies provided support for self-efficacy, social support, and craving as factors that likely influence people’s behaviors in treatment or recovery. The researchers called for these three constructs to be incorporated into AUD and SUD treatment and clinical training. Such an approach could improve recovery interventions, inform new treatments and clinical training, help clinicians align patients with approaches likely to work for them, and hone community-based recovery programs.

The researchers called for additional research on how these three concepts drive behavior change and for mining existing science to identify other evidence-based approaches. They recommended several directions for future research. These included expanding the examined outcomes to other manifestations of mental and physical health and experimenting with key elements of treatment to generate direct evidence of associations between those constructs and outcomes. Investigating the roles of context (such as policies, incentives, social norms, and settings) and combinations of influences could improve outcomes across varied real-world situations. Specifying how behavioral change occurs—such as the relevant neurological and biological pathways—is a critical gap that needs to be addressed.

From alcohol and other drug (AOD) treatment mediator to mechanism to implementation: A systematic review and the cases of self-efficacy, social support, and craving. S. Maisto, D. Moskal, M. Firkey, B. Bergman, B. Borsari, K. Hallgren, J. Houck, M. Villarosa-Hurlocker, B. Kiluk, A. Kuerbis, A. Reid, M. Magill.

ACER-24-6054.R1