title: Harm reduction for young people who use prescription opioids extra-medically: Obstacles and opportunities.
abstract: Extra-medical prescription opioid (EMPO) use - intentional use without a prescription or outside of prescribed parameters - is a public health crisis in the United States and around the world. Epidemiological evidence suggests that the prevalence of EMPO use and adverse sequelae, including opioid overdose and hepatitis C infection, are elevated among people aged 18-25. Despite these preventable health risks, many harm reduction interventions are underutilized by, or inaccessible to, EMPO-using youth. In this commentary, we describe key harm reduction strategies for young people who use prescription opioids. We examine individual, social, and policy-level barriers to the implementation of evidence-based approaches that address EMPO use and related harms among young people. We highlight the need for expanded services and new interventions to engage this diverse and heterogeneous at-risk population. A combination of medical, social, and structural harm reduction interventions are recommended. Furthermore, research to inform strategies that mitigate particularly high-risk practices (e.g., polysubstance use) is warranted. Finally, we discuss how the meaningful involvement of youth in the implementation of harm reduction strategies is a critical component of the public health response to the prescription opioid epidemic.
authors.affiliation: Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912, USA. Electronic address: brandon_marshall@brown.edu.
authors.forename: Brandon D L
authors.initials: BD
authors.lastname: Marshall
authors.affiliation: Boston University School of Medicine, Department of Emergency Medicine, 771 Albany Street, Room 1208, Boston, MA 02118, USA; The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA.
authors.forename: Traci C
authors.initials: TC
authors.lastname: Green
authors.affiliation: Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912, USA.
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Yedinak
authors.affiliation: Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Health Policy & Management, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Hadland
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000701:Analgesics, Opioid / Q000009:adverse effects*; D019033:Delivery of Health Care, Integrated; D055030:Drug Users / Q000523:psychology*; D005260:Female; D040261:Harm Reduction; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010358:Patient Participation; D064226:Prescription Drug Diversion / Q000517:prevention & control*; D063487:Prescription Drug Misuse / Q000009:adverse effects / Q000517:prevention & control*; D015995:Prevalence; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Adolescence; Harm reduction; Prescription drug misuse; Prescription opioids; Youth