Colorado’s parental notification law can impede adolescent access to abortion, study says

THAT'S IT'S PURPOSE

The law, including the option for judicial bypass, places emotional, physical hurdles during vulnerable time, study participants report

University of Colorado Anschutz Medical Campus

Facebook

XLinkedInWeChatBlueskyMessageWhatsAppEmail

AURORA, Colo. (Jan. 27, 2025) – A new study led by researchers from the University of Colorado Anschutz Medical Campus has shed light on the burdens parental involvement laws impose on adolescents seeking abortion care, even in states like Colorado where abortion is protected. Researchers say these laws contribute to logistical barriers, heightened stress and delays in accessing care, disproportionately impacting vulnerable populations.

The study, published today in the Journal of Adolescent Health, analyzed the experiences of adolescents (ages 15-17) and young adults (18-22) who either sought or considered abortion in the past two years, including adolescents’ experiences navigating Colorado’s parental notification law. Parental involvement laws require adolescents to obtain consent from or notify their parents or guardians prior to obtaining abortion care, while judicial bypass allows them to attain approval through courts instead of involving a parent. Colorado mandates parental notification.

“The findings emphasize that these laws do not account for the nuanced realities of adolescents’ lives and family situations,” said Kate Coleman-Minahan, PhD, RN, associate professor at the University of Colorado College of Nursing and lead author of the study. “For some adolescents, involving a parent is not a safe or viable option, and the judicial process often exacerbates the challenges they face.”

Adolescents and young adults from families with unsupportive or unstable pre-pregnancy relationships often felt unable to disclose their pregnancy to a parent, and many adolescents experienced stress and lack of control due to Colorado’s parental notification law. Importantly, even those who willingly involved a parent faced logistical and emotional challenges due to the law.

Additionally, the judicial bypass process, intended to provide an alternative to mandated parental involvement, was described by participants as stressful and invasive. Participants reported that it delayed access to abortion and, in some cases, resulted in unwanted disclosure to others, violating the privacy the process is intended to protect.

“Proponents of these laws believe they improve family communication; we find no evidence of that in this study, and in fact we found the law complicated already complex family relationships and that adolescents accurately predict their parents' responses,” said Coleman-Minahan, emphasizing that adolescent participants with histories of family trauma or instability faced the greatest burdens, with added logistical hurdles, emotional distress and threats to their autonomy.

“This study is a telling picture of the harmful impact these laws can have on adolescents at a critical moment in their lives,” she said. “Colorado recently passed a constitutional amendment protecting the right to abortion, yet our research shows the parental notification law threatens adolescents’ ability to access abortion. This is timely now, given that Colorado has seen an increase in adolescents from out of state seeking abortion care, many of whom are traveling hundreds of miles and already face additional burdens.”

About the University of Colorado Anschutz Medical Campus

The University of Colorado Anschutz Medical Campus is a world-class medical destination at the forefront of transformative science, medicine, education and patient care. The campus encompasses the University of Colorado health professional schools, more than 60 centers and institutes and two nationally ranked independent hospitals - UCHealth University of Colorado Hospital and Children's Hospital Colorado – which see more than two million adult and pediatric patient visits yearly. Innovative, interconnected and highly collaborative, the CU Anschutz Medical Campus delivers life-changing treatments, patient care and professional training and conducts world-renowned research fueled by $910 million in annual research funding, including $757 million in sponsored awards and $153 million in philanthropic gifts. 

---

Journal

Journal of Adolescent Health

DOI

10.1016/j.jadohealth.2024.12.013 

Article Publication Date

27-Jan-2025

Changes in support for advance provision and over-the-counter access to medication abortion

JAMA Network Open

Facebook

XLinkedInWeChat
WhatsAppEmail

About The Study:

 In this serial cross-sectional analysis of people ages 15 to 49 before Dobbs and 1 year after Dobbs, findings suggested that national support for expanded access to medication abortion has grown. Alternative models of care, such as advance provision and over-the-counter, have the potential to offer a promising approach to abortion care, particularly for people living in abortion-restricted states. 

Corresponding Author: To contact the corresponding author, M. Antonia Biggs, PhD, email antonia.biggs@ucsf.edu.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamanetworkopen.2024.54767)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time

 http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2024.54767?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=011625

---

Journal

JAMA Network Open

 

Doctors test a new way to help people quit fentanyl 

Buprenorphine works for opioid use disorder. But a new way of starting it using small doses seems less effective, UCSF study finds.  

University of California - San Francisco

Facebook

XLinkedIWeChatBlueskyEmail

During the COVID-19 pandemic, when fentanyl overdoses surged, doctors were desperate to find ways of helping their patients.  

They knew that buprenorphine could help people stop using opioids, but it was much harder to start the treatment for those who used fentanyl, which lasts longer in the body. Taking buprenorphine while fentanyl is still active can push someone abruptly into withdrawal.  

So, they started giving patients small doses of the drug over a series of days to slowly build up the drug in their systems until their bodies could handle a higher dose of buprenorphine.   

Now, doctors at UC San Francisco have tested this microdosing approach, known as low-dose initiation, and found that most of the time it does not work. Of 126 participants, just 34% were able to work up to a full dose of buprenorphine using this new approach.  

Leslie W. Suen, MD, MAS, the study’s first author, said she was disappointed by the results but the findings need to be shared.  

“This doesn't seem like it’s working the way we had hoped,” said Suen, an assistant professor at the UCSF Division of General Internal Medicine and an addiction medicine specialist. “But when people expect it to work, and it doesn’t work for them, they feel like there’s something wrong with them.”    

The study, the largest evaluation of low-dose buprenorphine initiation, appears in JAMA Network Open on Jan. 24.   

Buprenorphine is the most widely used of the three drugs that are approved to treat opioid use disorder. Other treatments include methadone, which is dispensed through certified treatment clinics, and injectable naltrexone, a longer-acting treatment that is prescribed when a person is no longer physically dependent on opioids.  

Although buprenorphine is proven effective, the drug is largely underutilized due to a range of issues, including a dearth of physicians trained to prescribe the medication, insurance issues and stigma.   

Buprenorphine is what’s known as a partial opioid agonist, meaning that it works by only partly binding to the receptor that creates the “high” without offering the level of euphoria of stronger opioids.  

The promise of low-dose initiation   

Before the introduction of fentanyl, buprenorphine had higher success rates, but starting it often meant that people had to stop their opioid use and experience some withdrawal before taking it. If people had opioids in their bodies and took buprenorphine, they could experience extreme worsening of their withdrawal from the buprenorphine. Because heroin and other opioids leave the body predictably, starting buprenorphine was easy. People could stop their opioids, wait several hours, and then start buprenorphine.   

But fentanyl is stored longer in the fat cells, and it’s harder to predict how long it takes to leave the body. People would stop their opioid use and wait the appropriate amount before starting buprenorphine, but they would still experience precipitated withdrawal from fentanyl. Doctors hoped that slowly introducing the buprenorphine would help reduce the discomfort, and people could stop using fentanyl when they felt ready or once the buprenorphine got to a good dose.    

The participants were treated at two outpatient substance-use disorder clinics in San Francisco between May 2021 and November 2022. They opted either for seven days of taking low doses of buprenorphine before getting up to an optimal dose (dosing two or three times a day), or four days of treatment (dosing four times a day). Taking different doses can be confusing, so the researchers gave them the medication in a bubble pack to help them manage their treatment.   

At follow-up visits, 38% of those with the four-day regimen achieved successful buprenorphine initiation and 28% were successful on the seven-day protocol, for an overall success rate of 34%. Overall, 22% stayed on the drug for at least 28 days. Repeated attempts yielded lower rates of success than the first attempt.  

Suen said the findings indicate that more options are needed to support people initiating buprenorphine. She and her fellow researchers are already involved in a follow-up study to determine why this promising approach is proving to be less effective than hoped.  

Authors: Additional UCSF authors include Amy Y. Chiang, PhD, Hannah R. Snyder, MD, John Neuhaus, PhD, Janet M. Myers, PhD, Kelly R. Knight, PhD, and Alexander R. Bazazi, MD, PhD.  

Funding: The study was funded by the Agency for Healthcare Research and Quality (grant K12HS026383) and the National Institute on Drug Abuse (grants 1K23DA060329 and 2K24DA042720). See the study for disclosures.   
 

 

About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF's primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. UCSF School of Medicine also has a regional campus in Fresno. Learn more at ucsf.edu, or see our Fact Sheet.

###

 

Follow UCSF
ucsf.edu | Facebook.com/ucsf | YouTube.com/ucsf

---

Journal

JAMA Network Open

Smoking opioids is associated with lower mortality than injecting but is still high-risk

Society for the Study of Addiction

LinkedInWeChatBlueskyMessagWhatsAppEmail

A new study published today in the scientific journal Addiction has found that opioid smoking appears to be associated with lower mortality risk compared with opioid injecting. The authors, however, caution that opioid smoking still carries a substantial overdose risk and that these results should not be interpreted as suggesting that opioid smoking is safe.

The study analysed substance use treatment data from 2006 to 2021, comparing 287,481 individuals who reported smoking opioids as their primary form of substance use and an equal weighted number of individuals who reported injecting opioids as their primary form of substance use.  The outcome of interest was death during treatment, within one year of treatment admission.

The analysis found a mortality rate of 6.5 per 1000 person-years in the smoking cohort and 9.7 in the injection cohort.  The mortality rate ratio was 0.67, meaning people who primarily smoked opioids died at two-thirds of the rate of people who primarily injected opioids.

Although smoking rather than injecting opioids may mitigate some risks, smoking opioids still carries a significant risk of death.  Smoking recently surpassed injection as the most common route of administration identified among opioid-related fatal overdoses in the United States1, likely driven in part by the rising popularity of opioid smoking and the decrease in opioid injecting.2

Lead author Dr. George Karandinos, a clinical and research fellow at Massachusetts General Hospital and Harvard Medical School, comments: “Smoking opioids instead of injecting likely reduces injection-associated complications like the transmission of HIV and hepatitis C and other serious infections. Our study suggests that smoking also appears to be associated with a lower risk of death. Overestimating the safety of smoking, however, could encourage people to lower their vigilance against overdose, eliminating or reversing any potential risk reduction. People who use opioids and those caring for them must understand that while smoking may reduce harm relative to injection, opioid smoking is not safe. People who smoke opioids should still seek treatment, carry naloxone, avoid using opioids while alone, and avoid sharing smoking equipment, which can lead to inadvertent fentanyl resin exposure and overdose.”

Senior author Dr. Daniel Ciccarone adds: “Smoking opioids can be done to deliver a large and rapid dose, as would occur with injection use, and those specific ways of smoking have significant risk for overdose.”3

1Tanz LJ. Routes of drug use among drug overdose deaths — United States, 2020–2022. In: Morbidity and Mortality Weekly Report [internet]; 2024 [cited 2024 Feb 15];73. Available from: https://www.cdc.gov/mmwr/volumes/73/wr/mm7306a2.htm

2Karandinos G, Unick J, Ondocsin J, Holm N, Mars S, Montero F, et al. Decrease in injection and rise in smoking and snorting of heroin and synthetic opioids, 2000–2021. Drug and Alcohol Dependence. 2024 Oct 1;263:111419.

3Ciccarone D, Holm N, Ondocsin J, Schlosser A, Fessel J, Cowan A, Mars SG. Innovation and adaptation: The rise of a fentanyl smoking culture in San Francisco. PLoS One. 2024 May 22;19(5):e0303403. doi: 10.1371/journal.pone.0303403.

-- Ends –

For editors:

This paper is available to read online on the Wiley Online Library after the embargo has lifted (https://onlinelibrary.wiley.com/doi/10.1111/add.16740) or you may request an early copy from Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org.

To speak with lead author Dr. George Karandinos, please contact him at Massachusetts General Hospital by email (gkarandinos@mgh.harvard.edu), copying in McKenzie Ridings in the Massachusetts General Hospital External Communications team (mridings@mgb.org).

Full citation for article: Karandinos G, Unick J, and Ciccarone D.  Mortality risk among individuals who smoke opioids compared with those who inject: A propensity score-matched cohort analysis of US national treatment data. Addiction. 2025. DOI: 10.1111/add.16740

Primary funding: National Institutes of Health/National Institute on Drug Abuse, Research Grant, award number: R01 DA054190.

Declaration of interests: Dr. Ciccarone reports financial support as a scientific advisor to Celero Systems and as an expert witness for Motley-Rice LLC.

Addiction (www.addictionjournal.org) is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, gambling, editorials, and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884.

---

Journal

Addiction

DOI

10.1111/add.16740 

Method of Research

Observational study

Subject of Research

People

Article Title

Mortality risk among individuals who smoke opioids compared with those who inject: A propensity score-matched cohort analysis of US national treatment data

Article Publication Date

23-Jan-2025

COI Statement

Dr. Ciccarone reports financial support as a scientific advisor to Celero Systems and as an expert witness for Motley-Rice LLC.

Being born into poverty negatively affects children’s behavior

Children born into poor families are more likely to act out but where they grow up matters too

Peer-Reviewed Publication

University of Georgia

Facebook

XLinkedInWeChatBlueskyMessageWhatsAppEmail

Children born into poor families are more likely to exhibit aggressive, impulsive behaviors throughout childhood, according to a new study from the University of Georgia.

Previous research connects this type of behavior to a variety of poor outcomes. Children who act out can have trouble making friends, perform poorly in school and show reduced cognitive abilities.

In the long run, these problems can lead to dropping out of school, unemployment and poor financial management.

The researchers also found a connection between economic status at birth and where children grew up.

High poverty rates affect entire communities

Children born into poor families were more likely to misbehave, engaging in behaviors such as throwing tantrums, teasing, fighting, lying and cheating — regardless of whether they lived in neighborhoods with high or low poverty rates.

For children from wealthier families, though, where they grew up mattered.

At age 3, children from wealthier families who lived in high-poverty neighborhoods were about as likely to act out as their peers born into poor families.

The study relied on data from portions of the Future of Families and Child Wellbeing Study, following more than 1,600 children from birth to age 15.

“We know that family socioeconomic status affects children’s development a lot,” said Soobin Kim, lead author of the study and a postdoctoral researcher in UGA’s School of Social Work. “The major takeaway of this paper is that children born into poor families have consistently higher rates of behavior problems throughout their first 15 years of life than children who were born into not poor families.

“But we also highlight how living in a poor neighborhood can influence kids from wealthier families too.”

Being born poor comes with variety of disadvantages

 Being born into poverty can have lasting effects on children’s lives.

Children from low-income families are less likely to finish school, more likely to experience crime and mental health struggles, and often have limited access to health care services.

These disadvantages can make it incredibly challenging for individuals to break the cycle of poverty as they grow up.

Money problems also exacerbate family stress.

Parents who are worrying about finances are more likely to engage in stricter, more controlling parenting, which may backfire and lead to more acting out. They may also have less time or availability to actively participate in their children’s education, which can negatively impact development.

Addressing resource gaps key to leveling playing field

The researchers found children from low-income families consistently exhibit higher levels of problem behaviors throughout their first 15 years compared to kids from higher-income families. However, particularly around age 3, children from higher-income families who lived in low-income neighborhoods exhibited similar levels of problem behaviors.

"When children are very young, children and their families are highly affected by the lack of safety and resources … in poor neighborhoods.” —Soobin Kim, School of Social Work

“This suggests that when children are very young, children and their families are highly affected by the lack of safety and resources, such as access to day care, quality education and stable jobs, in poor neighborhoods,” Kim said. “But once children begin attending school and interacting with other friend groups, the neighborhood’s influence on child behavior seems to reduce.”

Addressing resource gaps tied to both family income and neighborhood conditions is key to leveling the playing field for children’s development, the researchers said.

Expanding programs like Head Start, a U.S. Department of Health and Human Services program aimed at supporting children’s growth and learning, may help curb behavioral differences in early childhood between children born in different socioeconomic circumstances.

For school-aged children, school social workers can play a critical role by fostering stronger peer relationships and promoting a sense of belonging at school.

Additionally, anti-poverty programs aimed at supporting families need to start early to close developmental and environmental gaps between children from different socioeconomic backgrounds, the researchers said.

The study was published in the Journal of Social Service Research. Co-authors include Rafael Engel, Sara Goodkind and Jeffrey Shook.

---

Journal

Journal of Social Service Research

DOI

10.1080/01488376.2024.2435345 

Article Title

Diverging Trajectories of Child Externalizing Behavior by Family Economic Status at Birth: The Mediating Role of Neighborhood Poverty

Adverse childhood experiences influence potentially dangerous firearm-related behavior in adulthood

Rutgers University

Facebook

XLinkedInWeChatBlueskyMessageWhatsAppEmail

Researchers at Rutgers University have found that adverse childhood experiences can make people more sensitive to potential threats from others, which in turn increases their risk of engaging in defensive gun use in adulthood.

Their study, published in the Journal of Psychiatric Research, used cross-sectional data from a subsample of 3,130 adults with firearm access drawn from a nationally representative sample of U.S. adults.

Those surveyed were asked about their childhood experiences with abuse and neglect, their levels of social distrust and sensitivity to perceived threats, depressive symptoms and their self-reported use of a gun for self-defense.

The authors first assessed the association between adverse childhood experiences and adulthood defensive gun use. They then evaluated the role of depressive symptoms and threat sensitivity in that relationship.

“Research that links risk factors from childhood to problems later in life often neglects the role that situational and cognitive factors might play,” said Sultan Altikriti, a postdoctoral fellow at the New Jersey Gun Violence Research Center and lead author of the study. “We tried to unpack the cognitive factors through which experiences from childhood affect behavior in adulthood.”

The findings showed that adverse childhood experiences increased adulthood levels of threat sensitivity and depression. However, only threat sensitivity was associated with defensive gun use. Further analyses suggested evidence that threat sensitivity accounts for some of the increased risk of defensive gun use among those with adverse childhood experiences.

“Sensitivity to threats from others and hypervigilance can cause people to see threats where they do not exist,” said Altikriti. “This sense of threat sensitivity can then lead to overreactions in neutral or ambiguous situations, which might lead to unnecessary gun use.”

Reducing adverse childhood experiences not only reduces the immediate harm and psychological impact but can reduce the cumulative harm throughout someone’s life, the researchers said. They added that because adverse childhood experiences are fixed in childhood and adolescence, interventions that interrupt the downstream mechanisms could be more feasible in dealing with the impact of these experiences on negative life outcomes.

The study’s coauthors include Daniel C. Semenza, director of Interpersonal Violence Research at the New Jersey Gun Violence Research Center at the Rutgers School of Public Health; Michael D. Anestis, executive director of the New Jersey Gun Violence Research Center at Rutgers; Alexander Testa, an assistant professor at the University of Texas Health Science Center at Houston; Dylan B. Jackson, an associate professor at the Johns Hopkins Bloomberg School of Public Health.

---

Journal

Journal of Psychiatric Research

DOI

10.1016/j.jpsychires.2024.12.030 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Adverse childhood experiences and defensive gun use: The indirect role of threat sensitivity and depressive symptoms