Background: Prenatal stimulant and opioid use continue to rise, with disproportionately higher rates observed in rural and socioeconomically disadvantaged populations. Objective: To examine the association between opioid and stimulant use patterns and prenatal care adequacy among women with substance use disorder (SUD) enrolled in the Drug-Free Moms and Babies (DFMB) program in West Virginia. Methods: Secondary data analysis of DFMB participants (2018-2022; N = 1264). Opioid and stimulant use were categorized into four mutually exclusive groups. Adequacy of prenatal care was measured using the Kessner Index, categorized as inadequate, intermediate, and adequate. Results: Pregnant women with SUD who used opioids only [AOR = 2.21 (1.38, 3.57)], stimulants only [AOR = 4.25 (2.01, 8.99)], or both [AOR = 5.42 (2.77, 10.62)] had higher odds of receiving inadequate prenatal care compared with women who did not use these substances. Similarly, women using opioids only [AOR = 2.10 (1.50, 2.94)], stimulants only [AOR = 2.27 (1.18, 4.39)], or both substances [AOR = 2.31 (1.24, 4.33)] were more likely to receive intermediate care. Discussion: While all substance-use groups demonstrated increased odds of inadequate or intermediate prenatal care, the risk was highest among women using both opioids and stimulants, followed by stimulant use alone. Conclusions: The study highlights the need to identify and address upstream factors that influence prenatal care engagement among rural pregnant women with SUD, particularly those using opioids and/or stimulants. Scientific significance: The study identifies the intersection between opioid and stimulant use, prenatal care utilization, and social determinants of health. Article summary: Opioid and stimulant use during pregnancy was associated with a higher risk of both inadequate and intermediate prenatal care utilization, with the greatest risk observed among those using both substances. Social factors, including social disadvantage, unplanned pregnancy, and larger family size, further contributed to inadequate prenatal care. Together, these findings highlight the need to address upstream social, structural, and substance-related barriers to improve prenatal care engagement and, ultimately, maternal and child health in rural populations.
Background Substance use (SU) and substance use disorders (SUD) are common and often co-occur with psychopathology including depression, anxiety, and emotional dysregulation (ED). The specific role of ED components, including impulsivity, and their links to various substances has not been fully studied. This research examines how impulse control relates to anxiety, depression, and SU in adolescents and young adults (AYA). Methods The study involved baseline data from 1246 participants aged 14–30 (M=20.07, SD=4.48) from behavioral health clinics, juvenile justice, juvenile rehabilitation, and high schools across four projects focused on opioid and other SU prevention. Analyses tested whether impulse control challenges mediated the indirect effects of depression and anxiety on SU (alcohol, cannabis, opioids). Results We fitted group structural mediation models in which mental health factors (depression or anxiety) predicted impulse control, which in turn predicted SU (alcohol, cannabis, opioids). Generally, AYA with high depression or anxiety had higher SU rates for alcohol and cannabis, and the associations were partly mediated by challenges in impulse control. Conclusion AYA with depression or anxiety are more likely to exhibit increased impulsivity and SU, and impulsivity further raised the risk of SU among those with depression or anxiety. Hence, careful monitoring of symptoms related to anxiety, depression, and impulsivity may help identify AYA at the highest risk for developing problematic SU and SUD.
Background Layperson-administered naloxone is increasingly common before emergency medical services (EMS) arrival. However, EMS care following naloxone administered by laypeople rather than trained responders remains poorly characterized. Methods This cross-sectional study used the 2023 National EMS Information System dataset and included 9–1–1 activations for individuals aged ≥ 16 years with an EMS impression of opioid overdose and documented naloxone administration before EMS arrival. Exposures were layperson-administered naloxone (LAN) or trained responder-administered naloxone (TRAN; e.g., police, firefighter). The primary outcome was subsequent EMS naloxone administration. Secondary outcomes included total number of EMS naloxone administrations, advanced airway intervention, cardiac arrest, and EMS transport. We used descriptive statistics, t-tests, and multivariable logistic regression estimating adjusted odds ratios (aOR). Results Among 26,087 EMS activations, 8016 (30.7%) received LAN and 18,071 (69.3%) TRAN. Any subsequent EMS naloxone administration was less frequent following LAN (24.4% vs. 34.8%; P < .001); when EMS did administer additional naloxone, the mean number of administrations was slightly higher following LAN (mean difference 0.05, 95%CI 0.02–0.09; P = .001). Advanced airway attempts (1.6% vs. 1.4%, P = .160) and cardiac arrest (6.6% vs. 6.0%, P = .080) were uncommon. EMS transport occurred less often after LAN (79.4% vs. 84.4%, P < .001). In adjusted analyses, LAN was associated with lower odds of subsequent EMS naloxone administration (aOR 0.73; 95%CI 0.68–0.78) and EMS transport (aOR 0.78; 95%CI 0.73–0.84). Conclusions Layperson-administered naloxone was associated with less frequent EMS naloxone administration and lower rates of EMS transport. These findings support layperson overdose response while highlighting the need to better understand post-overdose care trajectories.
