Biopsychosocial determinants of opioid use disorder (OUD) and implications for maternal and child health research: A scoping review

Hamisu M. Salihu, MD, PhD; Abraham Salinas, MD, PhD; Imelda Medina, MD, MPH; Janani Krishnaswami, MD, MPH; Muktar H. Aliyu, MD, DrPH

doi:10.5055/jom.2019.0488

Authors

Hamisu M. Salihu, MD, PhD
Abraham Salinas, MD, PhD
Imelda Medina, MD, MPH
Janani Krishnaswami, MD, MPH
Muktar H. Aliyu, MD, DrPH

DOI:

https://doi.org/10.5055/jom.2019.0488

Keywords:

Opioids, women, maternal and child health, biopsychosocial model, United States

Abstract

Background: Opioid use disorder (OUD) is on the rise among women of reproductive age in the United States, contributing to a marked increase in the incidence of adverse consequences on maternal and child health (MCH). There is a dearth of literature on the biopsychosocial determinants of OUD in MCH populations and their role in the current opioid epidemic. The aim of this study is to examine the epidemiology of OUD in the United States and develop a biopsychosocial research model of OUD among women of reproductive age.

Methods: Utilizing a scoping review methodology, a systematic search strategy was implemented using MEDLINE/PubMed, Integrated Library searches, and Google Scholar. Scholarly/peer-reviewed articles published up to July 2017, in English, and restricted to populations in the United States were eligible for inclusion. A qualitative synthesis of the selected studies was performed to summarize study findings.

Results: Multiple factors play a role at every level of the biopsychosocial model (BPSM) in OUD—from molecular (genetic, epigenetic), cellular-tissue, organ system, the person (psycho-affective, cognitive, and behavioral), to relationship-based (family, peers), community environment, healthcare-related, and policy levels.

Conclusion: Important research gaps persist at every level and highlight the need for multiple-level biopsychosocial research to enhance our understanding of the nature, extent, distribution, etiology, and consequences of OUD among women of reproductive age. Our biopsychosocial model of OUD can be used to guide innovative MCH epidemiology research.

Author Biographies

Hamisu M. Salihu, MD, PhD

Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas

Abraham Salinas, MD, PhD

Familias Unidas International, Inc., Miami, Florida; Center of Excellence in Maternal and Child Health, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida

Imelda Medina, MD, MPH

Familias Unidas International, Inc., Miami, Florida

Janani Krishnaswami, MD, MPH

Division of Preventive Medicine, Department of Family and Community Medicine, University of Texas Rio Grande Valley

Muktar H. Aliyu, MD, DrPH

Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee

References

Holden JE, Jeong Y, Forrest JM: The endogenous opioid system and clinical pain management. AACN Clin Issues. 2005; 16(3): 291-301.

Yazdy MM, Desai RJ, Brogly SB: Prescription opioids in pregnancy and birth outcomes: A review of the literature. J Pediatr Genet. 2015; 4(2): 56-70.

National Institutes of Health (NIH): Drugs, brains and behavior: The science of addiction. NIH Pub No. 14-5605. Printed April 2007. Bethesda, MD: NIH, 2014. Available at https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/soa_2014.pdf. Accessed June 18, 2018.

Crist RC, Doyle GA, Kampman KM, et al.: A delta-opioid receptor genetic variant is associated with abstinence prior to and during cocaine dependence treatment. Drug Alcohol Depend. 2016; 166: 268-271.

Mendez M, Morales-Mulia M: Role of mu and delta opioid receptors in alcohol drinking behaviour. Curr Drug Abuse Rev. 2008; 1(2): 239-252.

Poznanski P, Lesniak A, Korostynski M, et al.: Delta-opioid receptor antagonism leads to excessive ethanol consumption in mice with enhanced activity of the endogenous opioid system. Neuropharmacology. 2017; 118: 90-101.

Aragón-Poce F, Martinez-Fernández E, Márquez-Espinós C, et al.: History of opium. Int Congr Ser. 2002; 1242: 19-21.

National Institute on Drug Abuse: Drugs of abuse: Opioids. 2015. Available at https://www.drugabuse.gov/drugs-abuse/opioids. Accessed July 12, 2017.

SAMHSA: Prescription drug misuse and abuse. 2015. Available at https://www.samhsa.gov/prescription-drug-misuse-abuse. Accessed July 23, 2017.

WHO: Management of substance abuse: Information sheet on opioid overdose. 2014. Available at http://www.who.int/substance_abuse/information-sheet/en/. Accessed July 22, 2017.

Brook K, Bennett J, Desai SP: The chemical history of morphine: An 8000-year journey, from resin to de-novo synthesis. J Anesth Hist. 2017; 3(2): 50-55.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders : DSM-5. Washington; London: American Psychiatric Publishing, 2014.

Manchikanti L, Helm S 2nd, Fellows B, et al.: Opioid epidemic in the United States. Pain Physician. 2012; 15(3 suppl): ES9-ES38.

Substance Abuse and Mental Heal th Services Administration (US), Office of the Surgeon General (US): Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet]. Washington, DC: US Department of Health and Human Services, 2016. Available at http://www.ncbi.nlm.nih.gov/books/NBK424857/. Accessed June 18, 2018.

Bosman J: Inside a killer drug epidemic: A look at America's opioid crisis. 2017. Available at https://www.nytimes.com/2017/01/06/us/opioid-crisis-epidemic.html?_r=0. Accessed June 2, 2017.

CDC: Opioid overdose - Understanding the epidemic. 2016. Available at https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed June 3, 2017.

Clarke JL, Skoufalos A, Scranton R: The American opioid epidemic: Population health implications and potential solutions. Report from the National Stakeholder Panel. Popul Health Manag. 2016; 19(suppl 1): S1-S10.

Kolodny A, Courtwright DT, Hwang CS, et al.: The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annu Rev Public Health. 2015; 36: 559-574.

Krans EE, Patrick SW: Opioid use disorder in pregnancy: Health policy and practice in the midst of an epidemic. Obstet Gynecol. 2016; 128(1): 4-10.

Pryor JR, Maalouf FI, Krans EE, et al.: The opioid epidemic and neonatal abstinence syndrome in the USA: A review of the continuum of care. Arch Dis child Fetal Neonatal Ed. 2017; 102(2): F183-F187.

Maguire DJ, Taylor S, Armstrong K, et al.: Long-term outcomes of infants with neonatal abstinence syndrome. Neonatal Netw. 2016; 35(5): 277-286.

Merrill CTTH, Owens PLA. Reasons for Being Admitted to the Hospital through the Emergency Department for Children and Adolescents, 2004. Rockville, MD: Agency for Healthcare Research and Quality, 2007.

Salihu HM, Mogos MF, Salinas-Miranda AA, et al.: National trends in maternal use of opioid drugs among pregnancy-related hospitalizations in the United States, 1998 to 2009. Am J Perinatol. 2015; 32(3): 289-298.

Whiteman VE, Salemi JL, Mogos MF, et al.: Maternal opioid drug use during pregnancy and its impact on perinatal morbidity, mortality, and the costs of medical care in the United States. J Pregnancy. 2014; 2014: 906723.

Shainker SA, Saia K, Lee-Parritz A: Opioid addiction in pregnancy. Obstet Gynecol Surv. 2012; 67(12): 817-825.

Smith R, Fortin AH, Dwamena F, et al.: An evidence-based patient-centered method makes the biopsychosocial model scientific. Patient Educ Couns. 2013; 91(3): 265-270.

Alio AP, Richman AR, Clayton HB, et al.: An ecological approach to understanding black-white disparities in perinatal mortality. Matern Child Health J. 2010; 14(4): 557-566.

Mishra GD, Cooper R, Kuh D: A life course approach to reproductive health: Theory and methods. Maturitas. 2010; 65(2): 92-97.

Lu MC: Improving maternal and child health across the life course: Where do we go from here? Matern Child Health J. 2014; 18(2): 339-343.

Kuh D, Hardy R: A Life Course Approach to Women's Health. Oxford; New York: Oxford University Press, 2002.

Papadimitriou G: The “Biopsychosocial Model”: 40 years of application in psychiatry. Psychiatriki. 2017; 28(2): 107-110.

Alvarez AS, Pagani M, Meucci P: The clinical application of the biopsychosocial model in mental health: A research critique. Am J Phys Med Rehabil. 2012; 91(13 suppl 1): S173-S180.

Wade DT, Halligan PW: The biopsychosocial model of illness: A model whose time has come. Clin Rehabil. 2017; 31(8): 995-1004.

Adler RH: Engel's biopsychosocial model is still relevant today. J Psychosom Res. 2009; 67(6): 607-611.

St-Laurent J, De Wals P, Moutquin JM, et al.: Biopsychosocial determinants of pregnancy length and fetal growth. Pediatr Perinat Epidemiol. 2008; 22(3): 240-248.

Salihu HM, Salinas-Miranda A, de la Cruz C, et al.: The role of folic acid in fetal programming of birth phenotypes and early human development: A biopsychosocial perspective. J Dev Orig Health Dis. 2013; 4(6): 442-457.

Arksey H, O'Malley L: Scoping studies: Towards a methodological framework. Int J Soc Res Methodol. 2005; 8(1): 19-32.

Davis K, Drey N, Gould D: What are scoping studies? A review of the nursing literature. Int J Nurs Stud. 2009; 46(10): 1386-1400.

Kastner M, Tricco AC, Soobiah C, et al.: What is the most appropriate knowledge synthesis method to conduct a review? Protocol for a scoping review. BMC Med Res Methodol. 2012; 12: 114.

Khalil H, Peters M, Godfrey CM, et al.: An evidence-based approach to scoping reviews. Worldviews Evid Based Nurs. 2016; 13(2): 118-123.

Daudt HM, van Mossel C, Scott SJ: Enhancing the scoping study methodology: A large, inter-professional team's experience with Arksey and O’Malley's framework. BMC Med Res Methodol. 2013; 13: 48.

Pham MT, Rajic A, Greig JD, et al.: A scoping review of scoping reviews: Advancing the approach and enhancing the consistency. Res Synth Methods. 2014; 5(4): 371-385.

Hagell A, Bourke Dowling S: Scoping Review of Literature on the Health and Care of Mentally Disordered Offenders. London: Policy Research Bureau, 1999.

Degenhardt L, Charlson F, Mathers B, et al.: The global epidemiology and burden of opioid dependence: Results from the global burden of disease 2010 study. Addiction. 2014; 109(8): 1320-1333.

Center for Behavioral Health Statistics and Quality: Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. HHS Publication No. SMA 16-4984, NSDUH Series H-51. Washington, DC: Substance Abuse and Mental Health Services Administration, 2016. Available at http://www.samhsa.gov/data/. Accessed June 18, 2018.

NIDA: Prescription opioids and heroin. 2015. Available at https://www.drugabuse.gov/publications/research-reports/prescription-opioids-heroin. Accessed July 23, 2017.

CDC: Opioid overdose - Prescribing data. 2016. Available at https://www.cdc.gov/drugoverdose/data/prescribing.html. Accessed June 3, 2017.

Reddy UM, Davis JM, Ren Z, et al.: Opioid use in pregnancy, neonatal abstinence syndrome, and childhood outcomes: Executive summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Maternal-Fetal Medicine, Centers for Disease Control and Prevention, and the March of Dimes Foundation. Obstet Gynecol. 2017; 130(1): 10-28.

Centers for Disease Control and Prevention: Vital signs: Prescription painkiller overdoses: A growing epidemic, especially among women. 2016. Available at http://www.cdc.gov/vitalsigns/prescriptionpainkilleroverdoses/. Accessed July 21, 2017.

International Narcotics Control Board: Report of the International Narcotics Control Board for 2010. New York, NY: United Nations, 2010. E/INCB/2010/1.

Rudd RA, Seth P, David F, et al.: Increases in drug and opioid-involved overdose deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016; 65(5051): 1445-1452.

CDC: Opioid overdose. 2017. Available at https://www.cdc.gov/drugoverdose/index.html. Accessed July 23, 2017.

CDC: Increases in drug and opioid-involved overdose deaths—United States 2010-2015. MMWR Morb Mortal Wkly Rep. 2016; 65(50-51): 1445-1452.

The Henry J. Kaiser Family Foundation: State Health Facts. San Francisco, CA: The Henry J. Kaiser Family Foundation, 2015. Available at https://www.kff.org/statedata/. Accessed June 18, 2018.

Florence CS, Zhou C, Luo F, et al.: The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016; 54(10): 901-906.

Kirson NY, Scarpati LM, Enloe CJ, et al.: The economic burden of opioid abuse: Updated findings. J Manag Care Spec Pharm. 2017; 23(4): 427-445.

Anand KJ, Campbell-Yeo M: Consequences of prenatal opioid use for newborns. Acta Paediatr. 2015; 104(11): 1066-1069.

Stover MW, Davis JM: Opioids in pregnancy and neonatal abstinence syndrome. Semin Perinatol. 2015; 39(7): 561-565.

Malek A, Mattison DR: Drugs and medicines in pregnancy: The placental disposition of opioids. Curr Pharm Biotechnol. 2011; 12(5): 797-803.

Patrick SW, Dudley J, Martin PR, et al.: Prescription opioid epidemic and infant outcomes. Pediatrics. 2015; 135(5): 842-850.

Smith K, Lipari R: Women of Childbearing Age and Opioids. Rockville, MD: SAMHSA, 2017.

Muri RM, Rivaud S, Gaymard B, et al.: Role of the prefrontal cortex in the control of express saccades. A transcranial magnetic stimulation study. Neuropsychologia. 1999; 37(2): 199-206.

McCarthy JJ, Leamon MH, Finnegan LP, et al.: Opioid dependence and pregnancy: Minimizing stress on the fetal brain. Am J Obstet Gynecol. 2017; 216(3): 226-231.

Forray A: Substance use during pregnancy. F1000Research. 2016; 5: F1000 Faculty Rev-1887.

Martin SL, Beaumont JL, Kupper LL: Substance use before and during pregnancy: Links to intimate partner violence. Am J Drug Alcohol Abuse. 2003; 29(3): 599-617.

Bailey BA: Partner violence during pregnancy: Prevalence, effects, screening, and management. Int J Womens Health. 2010; 2: 183-197.

Sugg N: Intimate partner violence: Prevalence, health consequences, and intervention. Med Clin North Am. 2015; 99(3): 629-649.

Children's Bureau: Parental Substance Use and the Child Welfare System. Washington, DC: Children's Bureau, 2014.

Barthell JE, Mrozek JD: Neonatal drug withdrawal. Minn Med. 2013; 96(3): 48-50.

Ko JY, Patrick SW, Tong VT: Incidence of neonatal abstinence syndrome—28 States, 1999-2013. MMWR Morb Mortal Wkly Rep. 2016; 65(31): 799-802.

Stabler ME, Long DL, Chertok IR, et al.: neonatal abstinence syndrome in West Virginia Substate Regions, 2007-2013. J Rural Health. 2017; 33(1): 92-101.

SAMHSA: Children Living with Substance-Dependent or Substance-Abuse Parents: 2002-2007. Rockville, MD: SAMHSA, 2009.

Child Trends: Foster care. 2015. Available at https://www.childtrends.org/indicators/foster-care/. Accessed June 2, 2017.

Koob GF, Volkow ND: Neurobiology of addiction: A neurocircuitry analysis. Lancet Psychiatry. 2016; 3(8): 760-773.

Fields HL, Margolis EB: Understanding opioid reward. Trends Neurosci. 2015; 38(4): 217-225.

Kreek MJ, Levran O, Reed B, et al. Opiate addiction and cocaine addiction: Underlying molecular neurobiology and genetics. J Clin Investig. 2012; 122(10): 3387-3393.

Self DW, Genova LM, Hope BT, et al. Involvement of cAMP-dependent protein kinase in the nucleus accumbens in cocaine self-administration and relapse of cocaine-seeking behavior. J Neurosci. 1998; 18(5): 1848-1859.

Edwards S, Koob GF: Neurobiology of dysregulated motivational systems in drug addiction. Future Neurol. 2010; 5(3): 393-401.

Carlezon WA Jr, Thome J, Olson VG, et al.: Regulation of cocaine reward by CREB. Science. 1998; 282(5397): 2272-2275.

Nestler EJ: Molecular mechanisms of drug addiction. Neuropharmacology. 2004; 47(suppl 1): 24-32.

Nestler EJ: Is there a common molecular pathway for addiction? Nat Neurosci. 2005; 8(11): 1445-1449.

Kelz MB, Chen J, Carlezon WA Jr, et al.: Expression of the transcription factor deltaFosB in the brain controls sensitivity to cocaine. Nature. 1999; 401(6750): 272-276.

Fattore L, Melis M, Fadda P, et al.: Sex differences in addictive disorders. Front Neuroendocrinol. 2014; 35(3): 272-284.

Bobzean SA, DeNobrega AK, Perrotti LI: Sex differences in the neurobiology of drug addiction. Exp Neurol. 2014; 259: 64-74.

Reed B, Butelman ER, Yuferov V, et al.: Genetics of opiate addiction. Curr Psychiatry Rep. 2014; 16(11): 504.

Andersen AM, Dogan MV, Beach SR, et al.: Current and future prospects for epigenetic biomarkers of substance use disorders. Genes. 2015; 6(4): 991-1022.

Nagaya D, Zahari Z, Saleem M, et al.: An analysis of genetic association in opioid dependence susceptibility. J Clin Pharm Ther. 2017; 43(1): 80-86.

Lerman C, Berrettini W: Elucidating the role of genetic factors in smoking behavior and nicotine dependence. Am J Med Genet Part B Neuropsychiatr Genet. 2003; 118B(1): 48-54.

Caine SB, Thomsen M, Gabriel KI, et al.: Lack of self-administration of cocaine in dopamine D1 receptor knock-out mice. J Neurosci. 2007; 27(48): 13140-13150.

Matthes HW, Maldonado R, Simonin F, et al.: Loss of morphine- induced analgesia, reward effect and withdrawal symptoms in mice lacking the mu-opioid-receptor gene. Nature. 1996; 383(6603): 819-823.

Ledent C, Valverde O, Cossu G, et al.: Unresponsiveness to cannabinoids and reduced addictive effects of opiates in CB1 receptor knockout mice. Science. 1999; 283(5400): 401-404.

Laakso A, Mohn AR, Gainetdinov RR, et al.: Experimental genetic approaches to addiction. Neuron. 2002; 36(2): 213-228.

Uhl GR, Grow RW: The burden of complex genetics in brain disorders. Arch Gen Psychiatry. 2004; 61(3): 223-229.

Nelson EC, Agrawal A, Heath AC, et al.: Evidence of CNIH3 involvement in opioid dependence. Mol Psychiatry. 2016; 21(5): 608-614.

Benowitz NL, Swan GE, Jacob P 3rd, et al.: CYP2A6 genotype and the metabolism and disposition kinetics of nicotine. Clin Pharmacol Ther. 2006; 80(5): 457-467.

Charbogne P, Kieffer BL, Befort K: 15 years of genetic approaches in vivo for addiction research: Opioid receptor and peptide gene knockout in mouse models of drug abuse. Neuropharmacology. 2014; 76(Pt B): 204-217.

Johnson SW, North RA: Opioids excite dopamine neurons by hyperpolarization of local interneurons. J Neurosci. 1992; 12(2): 483-488.

Levran O, Londono D, O'Hara K, et al.: Heroin addiction in African Americans: A hypothesis-driven association study. Genes Brain Behav. 2009; 8(5): 531-540.

Clarke T-K, Weiss ARD, Ferarro TN, et al.: The dopamine receptor D2 (DRD2) SNP rs1076560 is associated with opioid addiction. Ann Hum Genet. 2014; 78(1): 33-39.

Blum K, Oscar-Berman M, Demetrovics Z, et al.: Genetic Addiction Risk Score (GARS): Molecular neurogenetic evidence for predisposition to Reward Deficiency Syndrome (RDS). Mol Neurobiol. 2014; 50(3): 765-796.

Weaver IC, Cervoni N, Champagne FA, et al.: Epigenetic programming by maternal behavior. Nat Neurosci. 2004; 7(8): 847-854.

Ladd-Acosta C: Epigenetic signatures as biomarkers of exposure. Curr Environ Health Rep. 2015; 2(2): 117-125.

Starkman BG, Sakharkar AJ, Pandey SC: Epigenetics-beyond the genome in alcoholism. Alcohol Res. 2012; 34(3): 293-305.

Graham DL, Edwards S, Bachtell RK, et al.: Dynamic BDNF activity in nucleus accumbens with cocaine use increases self-administration and relapse. Nat Neurosci. 2007; 10(8): 1029-1037.

Lu L, Dempsey J, Liu SY, et al.: A single infusion of brain-derived neurotrophic factor into the ventral tegmental area induces long-lasting potentiation of cocaine seeking after withdrawal. J Neurosci. 2004; 24(7): 1604-1611.

Ting AKR, Vargas-Perez H, Bufalino MR, et al.: Infusion of brain-derived neurotrophic factor into the ventral tegmental area switches the substrates mediating ethanol motivation. Eur J Neurosci. 2013; 37(6): 996-1003.

Bowers MS, McFarland K, Lake RW, et al.: Activator of G protein signaling 3: A gatekeeper of cocaine sensitization and drug seeking. Neuron. 2004; 42(2): 269-281.

Munoa I, Urizar I, Casis L, et al.: The epigenetic regulation of the opioid system: New individualized prompt prevention and treatment strategies. J Cell Biochem. 2015; 116(11): 2419-2426.

Ajonijebu DC, Abboussi O, Russell VA, et al.: Epigenetics: A link between addiction and social environment. Cell Mol Life Sci. 2017; 74(15): 2735-2747.

Garland EL, Froeliger B, Zeidan F, et al.: The downward spiral of chronic pain, prescription opioid misuse, and addiction: Cognitive, affective, and neuropsychopharmacologic pathways. Neurosci Biobehav Rev. 2013; 37(10): 2597-2607.

Kosten TR, George TP: The neurobiology of opioid dependence: Implications for treatment. Sci Pract Perspect. 2002; 1(1): 13-20.

Sales JM, Irwin CE: A biopsychosocial perspective of adolescent health and disease. In O'Donohue WT (ed.): Handbook of Adolescent Health Psychology. New York, NY: Springer, 2013.

Ford J, Wright L: Prescription drug misuse and arrest history. Subst Use Misuse. 2017; 52(13): 1772-1777.

Sharma B, Bruner A, Barnett G, et al.: Opioid use disorders. Child Adolesc Psychiatr Clin N Am. 2016; 25(3): 473-487.

Simmons J, Singer M: I love you … and heroin: Care and collusion among drug-using couples. Subst Abuse Treat Prev Policy. 2006; 1: 7.

El-Bassel N, Gilbert L, Wu E, et al.: Relationship between drug abuse and intimate partner violence: A longitudinal study among women receiving methadone. Am J Public Health. 2005; 95(3): 465-470.

Simmons J: The interplay between interpersonal dynamics, treatment barriers, and larger social forces: An exploratory study of drug-using couples in Hartford, CT. Subst Abuse Treat Prev Policy. 2006; 1: 12.

Center for Substance Abuse Treatment: Chapter 2: Impact of substance abuse on families. Substance Abuse Treatment and Family Therapy. Treatment Improvement Protocol (TIP) Series No. 39. Rockville, MD: Center for Substance Abuse Treatment, 2004. Available at https://www.ncbi.nlm.nih.gov/books/NBK64258/. Accessed June 18, 2018.

Reilly DM: Drug-abusing families: Intrafamilial dynamics and brief triphasic treatment. In Kaufman E, Kaufmann P (eds.): Family Therapy of Drug and Alcohol Abuse. 2nd ed. Boston: Allyn and Bacon, 1992: 105-119.

Compton WM, Thomas YF, Conway KP, et al.: Developments in the epidemiology of drug use and drug use disorders. Am J Psychiatry. 2005; 162(8): 1494-1502.

Ford JA, Sacra SA, Yohros A: Neighborhood characteristics and prescription drug misuse among adolescents: The importance of social disorganization and social capital. Int J Drug Policy. 2017; 46: 47-53.

Joynt M, Train MK, Robbins BW, et al.: The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States. J Gen Intern Med. 2013; 28(12): 1604-1610.

Joranson DE: Federal and state regulation of opioids. J Pain Symptom Manage. 1990; 5(1 suppl): S12-S23.

Center for Substance Abuse Work G, Federation of State Medical B: Model policy guidelines for opioid addiction treatment in the medical office. Pain Physician. 2003; 6(2): 217-221.

Sandlin D: The new Joint Commission Accreditation of Healthcare Organizations’ requirements for pain assessment and treatment: A pain in the assessment? J Perianesth Nurs. 2000; 15(3): 182-184.

Joranson DE, Gilson AM, Dahl JL, et al.: Pain management, controlled substances, and state medical board policy: A decade of change. J Pain Symptom Manage. 2002; 23(2): 138-147.

Ohio PCSAO: The Opioid Epidemic's Impact on Children Services in Ohio. Columbus, OH: Public Children Services Association of Ohio, 2017.

Blackman K: Preventing opioid misuse: Legislative trends and predictions. 2017. Available at http://www.ncsl.org/blog/2017/01/31/preventing-opioid-misuse-legislative-trendsand-predictions.aspx. Accessed June 3, 2017.

Surratt HL, O'Grady C, Kurtz SP, et al.: Reductions in prescription opioid diversion following recent legislative interventions in Florida. Pharmacoepidemiol Drug Saf. 2014; 23(3): 314-320.

National Center on Substance Abuse and Child Welfare: Family Treatment Drug Courts. Available at https://www.ncsacw.samhsa.gov/resources/resources-drug-courts.aspx. Accessed June 3, 2017.

JBS International IaTCfCaFF, Inc.: Family-Centered Treatment for Women with Substance Use Disorders - History, Key Elements, and Challenges. Rockville, MD: SAMHSA Center for Substance Abuse Treatment, 2007.