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- 7 - accessHealthNews.net May 2022 Volume 8 | Issue No. 57 R ecently, the Bureau of Primary Health Care Behavioral Health Technical Assistance hosted an informational webinar for health care providers about polysubstance misuse in the primary care setting. Presenter Joseph Hyde, MA, LMHC, CAS, has nearly 40 years of experience working with substance use prevention, intervention, and treatment. Substance use and substance use disorder (SUD) are complex, Hyde said, but screening doesn't have to be. Despite the growing resurgence of synthetic drugs, the most commonly misused substance is still alcohol, which retains more use-related morbidity and mortality than other substances. Cannabis and opioids are the second and third most popular substances, respectively, though use of methamphetamines continues to rise. Polysubstance use is not a new trend. The use of more than one substance concurrently was popular when Hyde began working in addictions treatment in 1980. However, many of the drugs involved in polysubstance use today are far more lethal than in years past. Drugs like fentanyl, including new strains which are much more potent, carry high risks of overdose, neurotoxicity, organ damage, and death, Hyde said. "The risks are much higher today than they were then, in terms of mortality." Some places call these synthetic drugs names like synthetic THC or synthetic cannabis, but they have nothing to do with marijuana, and their neurotoxicity is "profound," Hyde said. These lethal chemicals contribute to a large portion of the increase in synthetic use. Fentanyl is another drug whose abuse is on the rise. Fentanyl is a hundred times more potent than heroin — but carfentanyl is 10,000 times more potent than morphine. "I'm not an alarmist by nature, but the combinations of these things are really scary. I have friends, and friends of friends, who have buried children. It is a very scary time." At-risk populations Transition-age youth (TAY), defined as 18 to 25-year- olds, have the highest rates of polysubstance use and comorbid mental health conditions. According to data drawn from validated screens, 29% of teenagers age 13- 17, and 39% of transition-age adults, are at risk, meaning their patterns of use put them at greater chance of harm — psychological, physical, or social. At the same time, 12% of youth are experiencing moderate to severe depression, and 9% have suicidal ideation — but that number jumps to 12% among TAY. Anxiety shows similar patterns, wherein the number of people reporting moderate to severe anxiety rises sharply between youth and young adults. These statistics are changing the way some groups do screening. As opposed to waiting for a child to show a sufficient number of depressive warning signs before screening for self-harm, said Hyde, it may be better to screen without waiting. "There are some kids who may be considering self-harm, but they score too low just in terms of those up-front depressive symptoms." One of the groups at highest risk for many problems is transition-age youth who are aging out of child welfare systems, such as foster homes. Of this group, 42% experienced homelessness by the age of 21, more than 25% had been referred for SUD treatment, a third had been incarcerated, about 34% were uninsured, and a quarter had no primary care provider. Especially for the uninsured, "oftentimes the emergency department is their primary care," said Hyde. "It's a major fault in the system, how these kids transitioning out of child welfare are being maintained." According to data drawn from validated screens, 29% of teenagers age 13-17, and 39% of transition-age adults, are at risk, meaning their patterns of use put them at greater chance of harm — psychological, physical, or social. READ MORE

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