title: The added risk of opioid problem use among treatment-seeking youth with marijuana and/or alcohol problem use.
abstract: OBJECTIVE
  To determine the added risk of opioid problem use (OPU) in youth with marijuana/alcohol problem use (MAPU).
  
  
  METHODS
  A total of 475 youth (ages 14-21 years) with OPU + MAPU were compared to a weighted sample of 475 youth with MAPU only (i.e. no OPU) before and after propensity score matching on gender, age, race, level of care and weekly use of marijuana/alcohol. Youth were recruited from 88 drug treatment sites participating in eight Center for Substance Abuse Treatment-funded grants. At treatment intake, participants were administered the Global Appraisal of Individual Need to elicit information on demographic, social, substance, mental health, human immunodeficiency virus (HIV), physical and legal characteristics. Odds ratios with confidence intervals were calculated.
  
  
  RESULTS
  The added risk of OPU among MAPU youth was associated with greater comorbidity; higher rates of psychiatric symptoms and trauma/victimization; greater needle use and sex-related HIV risk behaviours; and greater physical distress. The OPU + MAPU group was less likely to be African American or other race and more likely to be aged 15-17 years, Caucasian; report weekly drug use at home and among peers; engage in illegal behaviors and be confined longer; have greater substance abuse severity and polydrug use; and use mental health and substance abuse treatment services.
  
  
  CONCLUSIONS
  These findings expand upon the existing literature and highlight the substantial incremental risk of OPU on multiple comorbid areas among treatment-seeking youth. Further evaluation is needed to assess their outcomes following standard drug treatment and to evaluate specialized interventions for this subgroup of severely impaired youth.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA. geetha.subramaniam@nih.gov
authors.forename: Geetha A
authors.initials: GA
authors.lastname: Subramaniam
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Ives
authors.forename: Maxine L
authors.initials: ML
authors.lastname: Stitzer
authors.forename: Michael L
authors.initials: ML
authors.lastname: Dennis
mesh_terms: D000293:Adolescent; D001741:Black or African American; D000367:Age Factors; D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D002648:Child; D015897:Comorbidity; D003415:Crime / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000523:psychology* / Q000534:rehabilitation; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D012307:Risk Factors; D012309:Risk-Taking; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D044465:White People; D055815:Young Adult
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