Opioid overdose deaths involving other substances more common in youth

Results of a new study show that opioid overdose deaths involving more than one substance (polysubstances) are more common than opioid-only overdose deaths among youth. Led by researchers at Boston Medical Center's Grayken Center for Addiction, the data shows that cocaine and other stimulants like crystal methamphetamine are the substances most commonly involved in opioid overdose deaths in young people between the ages of 13 and 25. The study also provides novel data about opioid overdose deaths involving stimulants in young people, as those rates increased 351 percent between 2010 and 2018. Published in JAMA Pediatrics, the study emphasizes that in order to address the national overdose crisis, special attention must be paid to adolescents and young adults, and cannot focus solely on opioids.

A study published in 2018 found that 8,986 adolescents and young adults died from opioid poisoning between 1999 and 2016, and the mortality rate increased 268 percent during that time. Data from the Centers for Disease Control and Prevention (CDC) shows an increase in opioid overdose deaths involving other substances in adults, including cocaine and methamphetamine, between 1999 and 2018.

"Our study provides significant insight into what is driving opioid-related overdoses among adolescents and young adults, which can help improve treatment and outcomes in this population," said Scott Hadland, MD, pediatrician and addiction specialist at Boston Medical Center who serves as the study's senior author. Hadland is also an assistant professor of pediatrics at Boston University School of Medicine.

Researchers utilized cross-sectional data from the CDC's Wide-Ranging Online Data for Epidemiologic Research. They included entries categorized as deaths involving multiple causes, and identified deaths involving opioids such as fentanyl, heroin, and prescription pills for the period between January 1999 and December 2018 in youth aged 13 to 25 years. Opioid overdose death data were captured and further broken down by the presence of other substances, including benzodiazepines, alcohol, antidepressants, cannabis, antipsychotics, barbiturates, cocaine and other psychostimulants. Data involving sex, age, race/ethnicity and census region were also analyzed.

The rates of opioid-only and polysubstance-involved opioid overdose deaths increased dramatically during the study period, by 384 and 760 percent, respectively. In 2018, there were 4,623 opioid overdose deaths among youth, and synthetic opioids were most commonly involved (73 percent). Of those deaths, more than half (2,476) involved multiple substances, meaning that overdoses deaths involving more than just opioids were more common than those involving opioids alone. Stimulants, mainly cocaine, contributed to 1,541 opioid overdose deaths, which represented more than 33 percent of total overdoses and 66 percent of the polysubstance overdose deaths in 2018.

"These results emphasize that we need to be focusing on more than just opioids when treating young people with opioid use disorder," said Jamie Lim, MD, a pediatrics resident at BMC and Boston Children's Hospital, who is the study's corresponding author. "As providers, we need to recognize that co-occurring substance use disorders are common, and they must be addressed simultaneously when treating opioid addiction."