Adolescent Psychiatry - Volume 15, Issue 1, 2025

The opioid epidemic continues to make a significant impact on public health across multiple domains. While patients with opioid use disorders (OUD) remain in the face of this epidemic, the effect of the opioid epidemic, including on children and families, remains unheard. The impact of the opioid crisis is felt the most by individuals who do not use opioids themselves, with children being the most vulnerable victims of the opioid epidemic, an aspect of this epidemic that receives far less attention. The socio-ecological model approach is used to increase awareness of the lived experiences of children growing up in households with OUD and to promote the incorporation of treatment considerations based on available research. A literature review was conducted using computer-based searches using PubMed, PsycINFO, Medline, and Google Scholar databases. This entailed searching according to the following keywords (or stems when possible): opioids, opioid overdose, parental opioid use, child maltreatment, resilience, and adverse childhood experiences. Keywords were combined by using the Boolean operators “AND” and “OR”. Additionally, the ancestry approach, where potential studies were identified from the reference sections of existing reviews on the association between opioids and children, was used. Given that prenatal opioid use is extensively studied, and our focus was on lived experiences, studies focused solely on the effects of prenatal opioid use were excluded. Selected studies were varied in scope and methodologies. We reviewed the bibliographies of identified studies for additional studies and used both forward and backward searching. The economic cost of OUD and fatal opioid overdose is staggering and estimated to be about $1.02 trillion. Exposure to parental opioid use in childhood can have a significant impact on children's current and future lives. Conversely, for parents with OUD, children often provide a strong motivation for treatment. Children of adults with OUD are at higher risk of early exposure and initiation of opioid misuse. Opioid exposure in childhood, in turn, is associated with adult opioid misuse and OUD. Screening at healthcare visits is advocated to detect and mitigate the impact of OUD on children. The odds of using school-based mental health services are greater in boys compared to girls. Emerging evidence suggests that boys manifest less resiliency in the face of parental opioid exposure. This indicates a more nuanced understanding of the developmental outcomes of parental opioid exposure.

Adolescence is a sensitive phase of human life featuring changes in physical, emotional, and social characteristics. Many teens experience stressful events and trauma, which can affect their mental health and increase their risk of initiating and continuing substance use. Genetic vulnerabilities impact this relationship. In the face of trauma, while some adolescents are vulnerable, others navigate similar experiences differently, show resilience, and generally fare better without developing substance use problems. Understanding the multiple contributory factors that impact this relationship is critical in informing clinical approaches and program development. To describe the intricate dynamics between trauma, resilience, and substance abuse among adolescents. This review attempts to offer a synopsis that clarifies existing perspectives on trauma and substance use in adolescents while indicating areas for future research, clinical, and intervention programs in this critical area of adolescent well-being. A literature review was conducted to reveal available studies related to trauma, adolescent substance use, and resilience. Synthesis of findings from empirical studies, a detailed discussion on trauma and developmental factors while also addressing resilience elements alongside patterns of substance use is presented. The review highlights the bidirectional connections between trauma and substance use in adolescents. We include the consideration of resilience in adolescent responses to trauma. Resilience may reduce the risk of substance use, improve treatment-seeking and engagement in the treatment of SUD in adolescents, and reduce the risk of relapse, thereby suggesting it is a third dimension in the relationship between trauma and substance use. This review also provides evidence-based interventions and policies that are tailored to the specific needs of a diverse population of adolescents. We uncover the gaps in research, especially regarding cultural specifics and intersectionality among marginalized identities. Trauma, resilience, and substance use are linked in a tri-directional relationship, which is complex and dynamic. Adolescents with trauma are at higher risk of initiating and continuing substance. Resilience impacts treatment-seeking and engagement and may reduce relapse risk. Future research recommendations include improving the cultural sensitivity of interventions, studying the effects of marginalized identities, and ensuring rigorous evaluation of and progressive development of intervention programs.

Adolescence is a unique developmental period marked by biophysiological changes and psychosocial exploration. Risk-taking behaviors, including experimentation with psychoactive substances, are common during this period. Emergency room (ER) visits for adverse events related to adolescent substance use have increased over the last two decades. Without a continuum of care from the ER, significant opportunities to intervene are missed. The narrative review article aims to provide an overview of substance use during Adolescence in the United States, highlight related ER visits, and discuss extending care beyond the ER. A literature review was conducted to reveal historical and recent studies related to adolescent substance use trends, morbidity, and mortality patterns, as well as the much-needed continuum of care after the ER. Our approach prioritized capturing diverse perspectives and significant studies relevant to these themes, aiming for a thorough discussion without strict adherence to systematic review methodologies. The selection of studies involved a comprehensive search across multiple databases, including PubMed, Google Scholar, and relevant academic journals. Search terms were tailored to capture studies addressing adolescent substance abuse, ER visitation, and aftercare. Studies were screened based on title, abstract, and full-text review, with a focus on relevance and significance to the review's objectives. The strategy for this narrative review facilitated a detailed exploration of the selected themes while also allowing for flexibility in study selection and interpretation. National studies indicate an overall decline in the proportions of adolescents using substances compared to pre-COVID-19 levels. However, morbidity and mortality patterns have not mirrored this decline. Various factors, including gender, location, and specific mental health disorders, are associated with adolescent substance use presentations. Acute care providers in emergency settings, employing protocols like SBIRT, can significantly impact outcomes by facilitating appropriate screening and referral to aftercare treatment programs. Identification of barriers to care, such as stigma and social determinants of health, is important in formulating tailored interventions. While acute care provides an opportunity to intervene and initiate treatment, a continuum of care is essential to reduce morbidity and mortality patterns among adolescents with substance use.