Publications by authors named "Erin R McKnight"

8 Publications

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Patient and Clinician Perspectives on Adolescent Opioid Use Disorder Treatment During a Pandemic: One Step Back, but Two Forward?

JMIR Pediatr Parent 2020 Oct 9;3(2):e23463. Epub 2020 Oct 9.

Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, OH, United States.

Opioid use disorder (OUD) is one of the most pressing public health problems in the United States and is highly prevalent among adolescents and young adults (AYAs). However, only a small percentage of AYAs with OUD ever receive treatment. Further, among those that do receive treatment, a substantial proportion of patients continue to struggle with OUD, and many prematurely drop out of treatment. These challenges have only been heightened in the face of the COVID-19 pandemic, but greater utilization of telehealth and mobile technologies by OUD patients may help counter these barriers, which ultimately may improve AYA OUD treatment in the postpandemic period. This viewpoint presents the perspective of a person in OUD recovery using online and mobile technology to support his own OUD recovery combined with thoughts from two clinicians supporting AYAs with OUD. Their perspectives may provide insights to help counter COVID-19-related consequences and offer clues to improving AYA OUD treatment in the long term.
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http://dx.doi.org/10.2196/23463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584981PMC
October 2020

Case 1: Abdominal Distention, Bloating, and an Intrauterine Device in a 19-year-old Girl.

Pediatr Rev 2020 Sep;41(9):481-484

Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, OH.

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http://dx.doi.org/10.1542/pir.2019-0073DOI Listing
September 2020

Immunity to Hepatitis B is Undetectable in the Majority of Adolescents and Young Adults Seeking Outpatient Medication Treatment for Opioid Use Disorder.

J Addict Med 2020 12;14(6):e359-e361

Department of Biobehavioral Health, The Pennsylvania State University, PA (SWS); Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, OH (SWS, ERM, SCM, AEB); Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH (ERM, SCM, AEB); Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH (AEB).

Objective: To assess prevalence and predictors of hepatitis B immune status among adolescents and young adults (AYA) seeking outpatient medication treatment for opioid use disorder (MOUD).

Study Design: A retrospective medical chart review was conducted of AYA seeking MOUD between January 1, 2013 through December 31, 2015. Inclusion criteria included: diagnosis of opioid use disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; received hepatitis serologic testing; and no evidence of prior or current hepatitis B infection. Hepatitis B immunization initiation was defined as a record of at least 1 hepatitis B vaccination; while receipt of at least 3 vaccinations indicated immunization completion. The presence of hepatitis B surface antibody (anti-HBs) was the primary outcome measure.

Results: Of the 193 patients that met eligibility criteria, the presence of anti-HBs was evident in 62 (32.1%). Hepatitis B immunization initiation and completion before presenting for MOUD was documented in 102 (52.9%) and 84 (43.5%). In multivariable logistic regression modeling, hepatitis B immunization initiation after infancy was associated with increased odds of having protective anti-HBs relative to immunization series initiation in infancy (OR 8.96, 95% CI 1.57-51.05). Completion of hepatitis B immunization series after infancy as compared to completion in infancy also increased the odds of protective anti-HBs (OR, 6.68, 95% CI 2.10-21.24).

Conclusions: Rates of immunity to hepatitis B were low in AYA seeking MOUD. It is important to immunize patients seeking MOUD for hepatitis B and follow up with checks for seroconversion.
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http://dx.doi.org/10.1097/ADM.0000000000000689DOI Listing
December 2020

Impact of Office-based Opioid Treatment on Emergency Visits and Hospitalization in Adolescents with Opioid Use Disorder.

J Pediatr 2020 04 7;219:236-242. Epub 2020 Feb 7.

Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, The Ohio State University, Columbus, OH; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH.

Objective: To determine if engagement in office-based opioid treatment decreases emergency department, urgent care visits, and hospitalizations for acute opioid-related events (OREs) among adolescents with opioid use disorder.

Study Design: This retrospective cohort study identified all emergent and outpatient visits among adolescents, age 10-19 years, referred for office-based opioid treatment between January 1, 2006 and December 31, 2016. Patients were dichotomized into 2 cohorts: those who did and did not engage in office-based opioid treatment. The primary end point was the difference in the proportion of visits over the study period for acute OREs between cohorts and within the office-based opioid treatment cohort before and after referral. Secondary end points assessed change in the proportion of outpatient visits for treatment unrelated to opioid use disorder.

Results: Four hundred five emergent and outpatient visits were identified: 285 (70.4%) in the office-based opioid treatment cohort and 120 (29.6%) in the non-office-based opioid treatment cohort. After office-based opioid treatment engagement, 27.8% of visits in the office-based opioid treatment cohort were for acute OREs vs 80.8% in the non-office-based opioid treatment cohort (OR, 0.092; 95% CI, 0.052-0.160; P < .001). Outpatient visits in the office-based opioid treatment cohort were 10.9 times that of non-office-based opioid treatment (OR, 10.9; 95% CI, 6.23-19.16; P < .001). Within the office-based opioid treatment cohort, emergent visits decreased from 76.1% to 27.8% (OR, 0.121; 95% CI, 0.070-0.210; P < .001) and the odds of outpatient services was 8.3 times more after engagement (OR, 8.27; 95% CI, 4.78-14.4, P < .001).

Conclusions: The absolute decrease in emergent visits for acute OREs was 53% in adolescents engaged in office-based opioid treatment, representing a relative decrease of 65.6% compared with adolescents not engaged. An analysis of visits before and after office-based opioid treatment demonstrated similar decreases, suggesting that office-based opioid treatment has a significant impact in decreasing acute OREs in the adolescent population.
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http://dx.doi.org/10.1016/j.jpeds.2019.12.058DOI Listing
April 2020

An exploratory study of depot-medroxyprogesterone acetate and bone mineral density in adolescent and young adult women with cerebral palsy.

Contraception 2020 04 11;101(4):273-275. Epub 2020 Jan 11.

Division of Adolescent Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370 W 9th Avenue, Columbus, OH 43210, United States; Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.

Objective: To explore whether use of depot-medroxyprogesterone acetate (DMPA) in adolescent and young adult females with cerebral palsy is associated with lower bone mineral density (BMD).

Methods: A chart review of adolescent and young adult females with cerebral palsy who had undergone dual-energy X-ray absorptiometry, comparing BMD among those with (n = 19) and without DMPA (n = 84) exposure.

Results: BMD was similar in patients with and without DMPA exposure. All patients had low BMD, with average Z-scores of less than -2 at most sites.

Conclusion: Results suggest that DMPA is not associated with lower BMD in non-ambulatory adolescent and young adult females with cerebral palsy.
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http://dx.doi.org/10.1016/j.contraception.2019.12.009DOI Listing
April 2020

Multifaceted Quality Improvement Initiative Improves Retention in Treatment for Youth with Opioid Use Disorder.

Pediatr Qual Saf 2019 May-Jun;4(3):e174. Epub 2019 May 16.

Nationwide Children's Hospital, Columbus, Ohio.

Introduction: There is a critical need to develop interventions that help adolescents and young adults with opioid use disorders (OUDs) connect with, engage in, and remain consistent with the treatment given that patients who develop long-term OUDs experience long-term medical and mental health sequelae.

Methods: We implemented quality improvement (QI) processes to increase early engagement and 6-month retention within a medication-assisted treatment clinic for youth with OUDs. QI interventions included motivational interviewing (MI) staff training, implementation of reduced initial treatment requirements, reduction of access barriers to treatment, and enhancement of patient treatment motivation. We monitored the impact of the interventions via a p-chart.

Results: A statistically significant shift was seen in the 6-month retention rate following both MI staff training and the use of reduced initial treatment requirements. Second visit return rate also experienced a statistically significant shift following transportation support and an incentive program.

Discussion: Our data demonstrate that following MI staff training, reduced initial clinic requirements, transportation support, and utilization of an incentive program, the second visit return rate, and 6-month retention rate improved within an outpatient medication-assisted treatment clinic for youth with OUDs.
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http://dx.doi.org/10.1097/pq9.0000000000000174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594786PMC
May 2019

Statewide opioid prescriptions and the prevalence of adolescent opioid misuse in Ohio.

Am J Drug Alcohol Abuse 2017 05 19;43(3):299-305. Epub 2016 Sep 19.

a Nationwide Children's Hospital , Division of Adolescent Medicine , Columbus , OH , USA.

Background: Little is known about the relationship between opioid prescribing practices and the prevalence of adolescent opioid misuse.

Objective: To examine the relationships between both opioid prescriptions filled by adolescents and adults and adolescents seeking treatment for opioid misuse in Ohio.

Methods: Analyses of large statewide databases from 2008 to 2012, including all 88 counties in Ohio. The Ohio Board of Pharmacy provided data regarding prescription opioids filled by adolescents (12-20 years, N = 50,030,820 doses) and adults (>20 years, N = 3,811,288,395 doses) by county of residence. The Ohio Department of Mental Health and Drug Addiction Services provided annual treatment admissions for adolescent opioid misuse by county of residence (N = 6446).

Results: Adults filled prescriptions for nearly 100 oral opioid doses per capita annually, while adolescents filled prescriptions for approximately 7 oral opioid doses per capita annually. In Bayesian Poisson modeling examining the effect of annual adult per capita dose on adolescent treatment admissions, adjusted for annual adolescent per capita dose and year, an increase of one in the annual adult per capita opioid dose resulted in an increase of 1.3% (RR = 1.013, 95% HPD CI = [1.008, 1.017]) in the rate of adolescent treatment admissions. This association corresponds to a 99.99% chance that the adolescent treatment rate increases when the annual per capita adult dose is increased by one unit.

Conclusion: The amount of opioids filled by adults in Ohio, although relatively stable from 2008 to 2012, is approximately 13 times that filled by adolescents and is significantly associated with adolescents seeking treatment for opioid misuse. Efforts to decrease adolescent opioid misuse should also focus on reducing adult opioid prescriptions.
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http://dx.doi.org/10.1080/00952990.2016.1216999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357590PMC
May 2017
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