Psychotropic Medication Use by Foster Kids Comes Under Scrutiny

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CCHR says 25% of foster care children are subjected to psychotropic meds and calls for increased scrutiny. Medicaid accounts for 80% of all antipsychotic prescriptions in the U.S., costing more than $3.36 billion.

The Citizens Commission on Human Rights International, a mental health industry watchdog, says potential abuse of foster care children is a national concern because despite a slate of legislative reforms and reported stricter controls on dispensing of the drugs, nationwide one in four children in foster care between the ages 6 and 17 is administered at least one psychotropic drug.[1] Concerns have been prompted by recently released statistics that 34% of foster care children in Maryland are taking psychotropic drugs, especially antipsychotics.[2]

Medicaid is the country’s largest payer for antipsychotics, accounting for 80% of all antipsychotic prescriptions in the country.[3] Medicaid antipsychotic spending was around $166 million in 1991 and $3.36 billion in 2015—a whopping 2,087% increase.[4]

Total Medicaid enrollment increased by only 201% between 1990 (22.9 million) and nearly 69 million in 2016.

According to IQVia, in 2020, 6,155,852 0-17 year olds were taking psychotropic drugs, of which 418,425 were 0-5 year olds. There were 829,372 between the ages of 0 and 17 on antipsychotics.[5]

For years numerous advocacy groups and politicians have campaigned for better protections for foster youth. Since 2002, CCHR has contributed to the nationwide push against antipsychotic drugging of these children, helping to raise awareness through Congressional visits.

As of 2014, 31 state Medicaid programs required prior authorization for children to be prescribed certain antipsychotic drugs. The Centers for Medicare & Medicaid Services also required states to report on antipsychotic drug use by children.[6]

However, JooYeun Chang, Associate Commissioner of the Children’s Bureau in the federal Health and Human Services (HHS) testified before Congress that despite steps taken by the Administration and Congress to promote the monitoring and management of psychotropic drugs, there remained an over-use of the drugs for children in foster care.[7]

In 2015, an HHS Inspector General report showed very little change. Over half of the children receiving antipsychotics were victimized by “poor monitoring” of the drugs’ risky health side effects, which include breast growth in boys, cardiac arrest, extreme weight gain, and diabetes.[8]

One large study in children and youth and published in JAMA Psychiatry showed a three-fold increase in the risk of type II diabetes for those prescribed antipsychotics.[9]

“I’ve certainly seen obesity up to a 100-pound weight gain in six months. Boys with gynecomastia [breast growth] have had breast lumps and have been lactating, and some of them have had mastectomies,” said Dr. Stefan Kruszewski, a psychiatrist and whistleblower.[10]

Children and youths are also put at risk of a lifetime side effect: tardive dyskinesia, an incapacitating movement disorder.[11]

CCHR is also concerned about a potential link between foster care children being heavily drugged and them falling prey to human trafficking. According to the National Foster Youth Institute, 60% of human trafficking victims in the U.S. were involved in the foster care system at one time.[12]

Foster kids also constitute many of America’s sexually trafficked children.[13] A police chief magazine notes that creating a chemical dependency in the victim places the trafficker in a position of power, thus keeping the victim engaged in sex trafficking.[14]

According to the book, The Cause and Consequence of Human Trafficking: Human Rights Violations, “drugs are used to: induce compliance; create dependency; feed a ‘habit’; punish an unwilling victim; cope with the stress of sex trafficking; lure in a vulnerable and unsuspecting individual; criminalize a victim; and incapacitate a victim. In essence, they are weaponized in the trafficking arena.”[15]

While this is often done with the use of heroin or opioids, studies should determine links between foster youths being put on psychotropic drugs and sex trafficking exploitation.

CCHR says strong oversight and legal penalties are needed to protect foster children. While child abuse currently encompasses four categories—neglect, physical abuse, sexual abuse, and emotional abuse—because of the growing numbers of chemically altered foster children, a fifth category should be added: prescribed psychiatric drug abuse.

Increasing the criminal and civil penalties for those high prescribers to vulnerable foster children is also much-needed deterrent, CCHR says.

Read the full article here.

[1] “Ensuring Foster Youth Are Only Prescribed Psychotropic Medication When in Their Best Interest,” Patient-centered Outcomes Research Institute, www.pcori.org/research-results/2019/ensuring-foster-youth-are-only-prescribed-psychotropic-medication-when-their-best-interest; “Prescribing Antipsychotic Drugs to California Foster Youth Declines Dramatically,” The Imprint, 11 Sept. 2022, imprintnews.org/top-stories/prescribing-antipsychotic-drugs-to-california-foster-youth-declines/150795

[2] Collen Grablick, “Maryland Foster System Sued Over Administration Of Psychotropic Drugs In Children,” NPR, 17 Jan. 2023, dcist.com/story/23/01/17/maryland-lawsuit-psychotropic-drugs-children/

[3] Eric P. Slade Ph.D., et al., “Forecasting Medicaid Expenditures for Antipsychotic Medications,” Psychiatric Services, 31 Mar 2015, ps.psychiatryonline.org/doi/10.1176/appi.ps.201400042

[4] Y. Ying, “Price, utilization, and spending for antipsychotic medications in the Medicaid program,” Drug Benefits Trends, Jan 2007, www.researchgate.net/publication/288545418_Price_utilization_and_spending_for_antipsychotic_medications_in_the_medicaid_program; Dina Overland, “Medicaid to save billions as antipsychotic drug patents expire,” Fierce Pharma, 24 Aug. 2015, www.fiercehealthcare.com/payer/medicaid-to-save-billions-as-antipsychotic-drug-patents-expire

[5] www.cchrint.org/psychiatric-drugs/people-taking-psychiatric-drugs/

[6] Jack Hoadley and Joan Alker, “How Medicaid and CHIP Shield Children from the Rising Costs of Prescription Drugs,” Georgetown University Health Policy Unit, Center For Families and Children, July 2017

[7] www.cchrint.org/2021/10/20/high-rate-of-foster-care-children-are-prescribed-mind-altering-drugs/; Nidhi Subbaraman, “Missouri Has 23% of Its Foster Kids on Strong Psychoactive Drugs. A Lawsuit Claims the State Isn’t Keeping Records,” BuzzFeedNews, 2 Aug. 2018, www.buzzfeednews.com/article/nidhisubbaraman/missouri-foster-kids-psychotropic-drugs; Art Levine, “Feds Pay for Drug Fraud: 92 Percent of Foster Care, Poor Kids Prescribed Antipsychotics Get Them for Unaccepted Uses,” HuffPost, 30 Apr. 2015, www.huffpost.com/entry/feds-pay-for-drug-fraud-9_b_6966454; Marian Wright Edelman, “Overmedicating Children in Foster Care,” 22 May 2015, www.childrensdefense.org/child-watch-columns/health/2015/overmedicating-children-in-foster-care/

[8] www.cchrint.org/2021/10/20/high-rate-of-foster-care-children-are-prescribed-mind-altering-drugs/; “Second-Generation Antipsychotic Drug Use Among Medicaid-Enrolled Children: Quality-Of-Care Concerns,” GAO report, Mar. 2015, www.gao.gov/assets/gao-13-15.pdf

[9] Shawn Radcliff, “Antipsychotic Drugs May Increase Diabetes Risk in Children,” Healthline, 21 Aug. 2013, www.healthline.com/health-news/children-antipsychotics-raise-risk-of-type-2-diabetes-in-children-082113#Type-2-Diabetes-Set-to-Rise-in-Children; John Muench, Md, Mph, And Ann M. Hamer, PharmD, BCPP, “Adverse Effects of Antipsychotic Medications,” American Family Physician, March 1, 2010, www.aafp.org/pubs/afp/issues/2010/0301/p617.html; Daniel R. Levinson, Inspector General DHHS, “Second-Generation Anti-Psychotic Drug Use Among Medicaid-Enrolled Children: Quality-of-Care Concerns,” March 2015, oig.hhs.gov/oei/reports/oei-07-12-00320.pdf

[10] www.huffpost.com/entry/feds-pay-for-drug-fraud-9_b_6966454

[11] www.cchrint.org/2021/10/20/high-rate-of-foster-care-children-are-prescribed-mind-altering-drugs/

[12] preventht.org/editorial/foster-care-and-the-pipeline-to-human-trafficking/

[13] www.usatoday.com/story/opinion/columnist/2022/02/24/children-disappear-foster-care-trafficking/6829115001/

[14] www.policechiefmagazine.org/combating-drug-facilitated-sex-trafficking-of-runaway-youth/

[15] ohiostate.pressbooks.pub/humantrafficking/

The Citizens Commission on Human Rights International, a mental health industry watchdog, says potential abuse of foster care children is a national concern because despite a slate of legislative reforms and reported stricter controls on dispensing of the drugs, nationwide one in four children in foster care between the ages 6 and 17 is administered at least one psychotropic drug.[1] Concerns have been prompted by recently released statistics that 34% of foster care children in Maryland are taking psychotropic drugs, especially antipsychotics.[2]

Medicaid is the country’s largest payer for antipsychotics, accounting for 80% of all antipsychotic prescriptions in the country.[3] Medicaid antipsychotic spending was around $166 million in 1991 and $3.36 billion in 2015—a whopping 2,087% increase.[4]

Total Medicaid enrollment increased by only 201% between 1990 (22.9 million) and nearly 69 million in 2016.

According to IQVia, in 2020, 6,155,852 0-17 year olds were taking psychotropic drugs, of which 418,425 were 0-5 year olds. There were 829,372 between the ages of 0 and 17 on antipsychotics.[5]

For years numerous advocacy groups and politicians have campaigned for better protections for foster youth. Since 2002, CCHR has contributed to the nationwide push against antipsychotic drugging of these children, helping to raise awareness through Congressional visits.

As of 2014, 31 state Medicaid programs required prior authorization for children to be prescribed certain antipsychotic drugs. The Centers for Medicare & Medicaid Services also required states to report on antipsychotic drug use by children.[6]

However, JooYeun Chang, Associate Commissioner of the Children’s Bureau in the federal Health and Human Services (HHS) testified before Congress that despite steps taken by the Administration and Congress to promote the monitoring and management of psychotropic drugs, there remained an over-use of the drugs for children in foster care.[7]

In 2015, an HHS Inspector General report showed very little change. Over half of the children receiving antipsychotics were victimized by “poor monitoring” of the drugs’ risky health side effects, which include breast growth in boys, cardiac arrest, extreme weight gain, and diabetes.[8]

One large study in children and youth and published in JAMA Psychiatry showed a three-fold increase in the risk of type II diabetes for those prescribed antipsychotics.[9]

“I’ve certainly seen obesity up to a 100-pound weight gain in six months. Boys with gynecomastia [breast growth] have had breast lumps and have been lactating, and some of them have had mastectomies,” said Dr. Stefan Kruszewski, a psychiatrist and whistleblower.[10]

Children and youths are also put at risk of a lifetime side effect: tardive dyskinesia, an incapacitating movement disorder.[11]

CCHR is also concerned about a potential link between foster care children being heavily drugged and them falling prey to human trafficking. According to the National Foster Youth Institute, 60% of human trafficking victims in the U.S. were involved in the foster care system at one time.[12]

Foster kids also constitute many of America’s sexually trafficked children.[13] A police chief magazine notes that creating a chemical dependency in the victim places the trafficker in a position of power, thus keeping the victim engaged in sex trafficking.[14]

According to the book, The Cause and Consequence of Human Trafficking: Human Rights Violations, “drugs are used to: induce compliance; create dependency; feed a ‘habit’; punish an unwilling victim; cope with the stress of sex trafficking; lure in a vulnerable and unsuspecting individual; criminalize a victim; and incapacitate a victim. In essence, they are weaponized in the trafficking arena.”[15]

While this is often done with the use of heroin or opioids, studies should determine links between foster youths being put on psychotropic drugs and sex trafficking exploitation.

CCHR says strong oversight and legal penalties are needed to protect foster children. While child abuse currently encompasses four categories—neglect, physical abuse, sexual abuse, and emotional abuse—because of the growing numbers of chemically altered foster children, a fifth category should be added: prescribed psychiatric drug abuse.

Increasing the criminal and civil penalties for those high prescribers to vulnerable foster children is also much-needed deterrent, CCHR says.

Read the full article here.

[1] “Ensuring Foster Youth Are Only Prescribed Psychotropic Medication When in Their Best Interest,” Patient-centered Outcomes Research Institute, www.pcori.org/research-results/2019/ensuring-foster-youth-are-only-prescribed-psychotropic-medication-when-their-best-interest; “Prescribing Antipsychotic Drugs to California Foster Youth Declines Dramatically,” The Imprint, 11 Sept. 2022, imprintnews.org/top-stories/prescribing-antipsychotic-drugs-to-california-foster-youth-declines/150795

[2] Collen Grablick, “Maryland Foster System Sued Over Administration Of Psychotropic Drugs In Children,” NPR, 17 Jan. 2023, dcist.com/story/23/01/17/maryland-lawsuit-psychotropic-drugs-children/

[3] Eric P. Slade Ph.D., et al., “Forecasting Medicaid Expenditures for Antipsychotic Medications,” Psychiatric Services, 31 Mar 2015, ps.psychiatryonline.org/doi/10.1176/appi.ps.201400042

[4] Y. Ying, “Price, utilization, and spending for antipsychotic medications in the Medicaid program,” Drug Benefits Trends, Jan 2007, www.researchgate.net/publication/288545418_Price_utilization_and_spending_for_antipsychotic_medications_in_the_medicaid_program; Dina Overland, “Medicaid to save billions as antipsychotic drug patents expire,” Fierce Pharma, 24 Aug. 2015, www.fiercehealthcare.com/payer/medicaid-to-save-billions-as-antipsychotic-drug-patents-expire

[5] www.cchrint.org/psychiatric-drugs/people-taking-psychiatric-drugs/

[6] Jack Hoadley and Joan Alker, “How Medicaid and CHIP Shield Children from the Rising Costs of Prescription Drugs,” Georgetown University Health Policy Unit, Center For Families and Children, July 2017

[7] www.cchrint.org/2021/10/20/high-rate-of-foster-care-children-are-prescribed-mind-altering-drugs/; Nidhi Subbaraman, “Missouri Has 23% of Its Foster Kids on Strong Psychoactive Drugs. A Lawsuit Claims the State Isn’t Keeping Records,” BuzzFeedNews, 2 Aug. 2018, www.buzzfeednews.com/article/nidhisubbaraman/missouri-foster-kids-psychotropic-drugs; Art Levine, “Feds Pay for Drug Fraud: 92 Percent of Foster Care, Poor Kids Prescribed Antipsychotics Get Them for Unaccepted Uses,” HuffPost, 30 Apr. 2015, www.huffpost.com/entry/feds-pay-for-drug-fraud-9_b_6966454; Marian Wright Edelman, “Overmedicating Children in Foster Care,” 22 May 2015, www.childrensdefense.org/child-watch-columns/health/2015/overmedicating-children-in-foster-care/

[8] www.cchrint.org/2021/10/20/high-rate-of-foster-care-children-are-prescribed-mind-altering-drugs/; “Second-Generation Antipsychotic Drug Use Among Medicaid-Enrolled Children: Quality-Of-Care Concerns,” GAO report, Mar. 2015, www.gao.gov/assets/gao-13-15.pdf

[9] Shawn Radcliff, “Antipsychotic Drugs May Increase Diabetes Risk in Children,” Healthline, 21 Aug. 2013, www.healthline.com/health-news/children-antipsychotics-raise-risk-of-type-2-diabetes-in-children-082113#Type-2-Diabetes-Set-to-Rise-in-Children; John Muench, Md, Mph, And Ann M. Hamer, PharmD, BCPP, “Adverse Effects of Antipsychotic Medications,” American Family Physician, March 1, 2010, www.aafp.org/pubs/afp/issues/2010/0301/p617.html; Daniel R. Levinson, Inspector General DHHS, “Second-Generation Anti-Psychotic Drug Use Among Medicaid-Enrolled Children: Quality-of-Care Concerns,” March 2015, oig.hhs.gov/oei/reports/oei-07-12-00320.pdf

[10] www.huffpost.com/entry/feds-pay-for-drug-fraud-9_b_6966454

[11] www.cchrint.org/2021/10/20/high-rate-of-foster-care-children-are-prescribed-mind-altering-drugs/

[12] preventht.org/editorial/foster-care-and-the-pipeline-to-human-trafficking/

[13] www.usatoday.com/story/opinion/columnist/2022/02/24/children-disappear-foster-care-trafficking/6829115001/

[14] www.policechiefmagazine.org/combating-drug-facilitated-sex-trafficking-of-runaway-youth/

[15] ohiostate.pressbooks.pub/humantrafficking/

CCHR says 25% of foster care children are subjected to psychotropic meds and calls for increased scrutiny. Medicaid accounts for 80% of all antipsychotic prescriptions in the U.S., costing more than $3.36 billion.

The Citizens Commission on Human Rights International, a mental health industry watchdog, says potential abuse of foster care children is a national concern because despite a slate of legislative reforms and reported stricter controls on dispensing of the drugs, nationwide one in four children in foster care between the ages 6 and 17 is administered at least one psychotropic drug.[1] Concerns have been prompted by recently released statistics that 34% of foster care children in Maryland are taking psychotropic drugs, especially antipsychotics.[2]

Medicaid is the country’s largest payer for antipsychotics, accounting for 80% of all antipsychotic prescriptions in the country.[3] Medicaid antipsychotic spending was around $166 million in 1991 and $3.36 billion in 2015—a whopping 2,087% increase.[4]

Total Medicaid enrollment increased by only 201% between 1990 (22.9 million) and nearly 69 million in 2016.

According to IQVia, in 2020, 6,155,852 0-17 year olds were taking psychotropic drugs, of which 418,425 were 0-5 year olds. There were 829,372 between the ages of 0 and 17 on antipsychotics.[5]

For years numerous advocacy groups and politicians have campaigned for better protections for foster youth. Since 2002, CCHR has contributed to the nationwide push against antipsychotic drugging of these children, helping to raise awareness through Congressional visits.

As of 2014, 31 state Medicaid programs required prior authorization for children to be prescribed certain antipsychotic drugs. The Centers for Medicare & Medicaid Services also required states to report on antipsychotic drug use by children.[6]

However, JooYeun Chang, Associate Commissioner of the Children’s Bureau in the federal Health and Human Services (HHS) testified before Congress that despite steps taken by the Administration and Congress to promote the monitoring and management of psychotropic drugs, there remained an over-use of the drugs for children in foster care.[7]

In 2015, an HHS Inspector General report showed very little change. Over half of the children receiving antipsychotics were victimized by “poor monitoring” of the drugs’ risky health side effects, which include breast growth in boys, cardiac arrest, extreme weight gain, and diabetes.[8]

One large study in children and youth and published in JAMA Psychiatry showed a three-fold increase in the risk of type II diabetes for those prescribed antipsychotics.[9]

“I’ve certainly seen obesity up to a 100-pound weight gain in six months. Boys with gynecomastia [breast growth] have had breast lumps and have been lactating, and some of them have had mastectomies,” said Dr. Stefan Kruszewski, a psychiatrist and whistleblower.[10]

Children and youths are also put at risk of a lifetime side effect: tardive dyskinesia, an incapacitating movement disorder.[11]

CCHR is also concerned about a potential link between foster care children being heavily drugged and them falling prey to human trafficking. According to the National Foster Youth Institute, 60% of human trafficking victims in the U.S. were involved in the foster care system at one time.[12]

Foster kids also constitute many of America’s sexually trafficked children.[13] A police chief magazine notes that creating a chemical dependency in the victim places the trafficker in a position of power, thus keeping the victim engaged in sex trafficking.[14]

According to the book, The Cause and Consequence of Human Trafficking: Human Rights Violations, “drugs are used to: induce compliance; create dependency; feed a ‘habit’; punish an unwilling victim; cope with the stress of sex trafficking; lure in a vulnerable and unsuspecting individual; criminalize a victim; and incapacitate a victim. In essence, they are weaponized in the trafficking arena.”[15]

While this is often done with the use of heroin or opioids, studies should determine links between foster youths being put on psychotropic drugs and sex trafficking exploitation.

CCHR says strong oversight and legal penalties are needed to protect foster children. While child abuse currently encompasses four categories—neglect, physical abuse, sexual abuse, and emotional abuse—because of the growing numbers of chemically altered foster children, a fifth category should be added: prescribed psychiatric drug abuse.

Increasing the criminal and civil penalties for those high prescribers to vulnerable foster children is also much-needed deterrent, CCHR says.

Read the full article here.

[1] “Ensuring Foster Youth Are Only Prescribed Psychotropic Medication When in Their Best Interest,” Patient-centered Outcomes Research Institute, www.pcori.org/research-results/2019/ensuring-foster-youth-are-only-prescribed-psychotropic-medication-when-their-best-interest; “Prescribing Antipsychotic Drugs to California Foster Youth Declines Dramatically,” The Imprint, 11 Sept. 2022, imprintnews.org/top-stories/prescribing-antipsychotic-drugs-to-california-foster-youth-declines/150795

[2] Collen Grablick, “Maryland Foster System Sued Over Administration Of Psychotropic Drugs In Children,” NPR, 17 Jan. 2023, dcist.com/story/23/01/17/maryland-lawsuit-psychotropic-drugs-children/

[3] Eric P. Slade Ph.D., et al., “Forecasting Medicaid Expenditures for Antipsychotic Medications,” Psychiatric Services, 31 Mar 2015, ps.psychiatryonline.org/doi/10.1176/appi.ps.201400042

[4] Y. Ying, “Price, utilization, and spending for antipsychotic medications in the Medicaid program,” Drug Benefits Trends, Jan 2007, www.researchgate.net/publication/288545418_Price_utilization_and_spending_for_antipsychotic_medications_in_the_medicaid_program; Dina Overland, “Medicaid to save billions as antipsychotic drug patents expire,” Fierce Pharma, 24 Aug. 2015, www.fiercehealthcare.com/payer/medicaid-to-save-billions-as-antipsychotic-drug-patents-expire

[5] www.cchrint.org/psychiatric-drugs/people-taking-psychiatric-drugs/

[6] Jack Hoadley and Joan Alker, “How Medicaid and CHIP Shield Children from the Rising Costs of Prescription Drugs,” Georgetown University Health Policy Unit, Center For Families and Children, July 2017

[7] www.cchrint.org/2021/10/20/high-rate-of-foster-care-children-are-prescribed-mind-altering-drugs/; Nidhi Subbaraman, “Missouri Has 23% of Its Foster Kids on Strong Psychoactive Drugs. A Lawsuit Claims the State Isn’t Keeping Records,” BuzzFeedNews, 2 Aug. 2018, www.buzzfeednews.com/article/nidhisubbaraman/missouri-foster-kids-psychotropic-drugs; Art Levine, “Feds Pay for Drug Fraud: 92 Percent of Foster Care, Poor Kids Prescribed Antipsychotics Get Them for Unaccepted Uses,” HuffPost, 30 Apr. 2015, www.huffpost.com/entry/feds-pay-for-drug-fraud-9_b_6966454; Marian Wright Edelman, “Overmedicating Children in Foster Care,” 22 May 2015, www.childrensdefense.org/child-watch-columns/health/2015/overmedicating-children-in-foster-care/

[8] www.cchrint.org/2021/10/20/high-rate-of-foster-care-children-are-prescribed-mind-altering-drugs/; “Second-Generation Antipsychotic Drug Use Among Medicaid-Enrolled Children: Quality-Of-Care Concerns,” GAO report, Mar. 2015, www.gao.gov/assets/gao-13-15.pdf

[9] Shawn Radcliff, “Antipsychotic Drugs May Increase Diabetes Risk in Children,” Healthline, 21 Aug. 2013, www.healthline.com/health-news/children-antipsychotics-raise-risk-of-type-2-diabetes-in-children-082113#Type-2-Diabetes-Set-to-Rise-in-Children; John Muench, Md, Mph, And Ann M. Hamer, PharmD, BCPP, “Adverse Effects of Antipsychotic Medications,” American Family Physician, March 1, 2010, www.aafp.org/pubs/afp/issues/2010/0301/p617.html; Daniel R. Levinson, Inspector General DHHS, “Second-Generation Anti-Psychotic Drug Use Among Medicaid-Enrolled Children: Quality-of-Care Concerns,” March 2015, oig.hhs.gov/oei/reports/oei-07-12-00320.pdf

[10] www.huffpost.com/entry/feds-pay-for-drug-fraud-9_b_6966454

[11] www.cchrint.org/2021/10/20/high-rate-of-foster-care-children-are-prescribed-mind-altering-drugs/

[12] preventht.org/editorial/foster-care-and-the-pipeline-to-human-trafficking/

[13] www.usatoday.com/story/opinion/columnist/2022/02/24/children-disappear-foster-care-trafficking/6829115001/

[14] www.policechiefmagazine.org/combating-drug-facilitated-sex-trafficking-of-runaway-youth/

[15] ohiostate.pressbooks.pub/humantrafficking/

Source: http://newswire.net/newsroom/pr/00000000-https-www-cchrint-org.html