(100) Trends in United States Adolescent and Young Adult Overdose Fatalities, 1999-2023

Background & Introduction: The overdose epidemic affects adolescents and young adults (AYA) in the United States (US); overdoses became the 3rd leading cause of death among youth under age 20 in 2020. Long-term trends in overdose fatalities among youth aged 10-24 have not been stratified by age and racial/ethnic group.

Methods: We extracted Centers for Disease Control and Prevention’s WONDER database’s overdose-related underlying/multiple cause of death data for ages 10-24 years from 1999-2023, including 2023 provisional data. Data related to International Classification of Disease Tenth Revision (ICD-10) codes including accidental overdoses (poisoning) X40-X44, suicides (self-poisoning) X60-X64, homicide X85-X90, and undetermined intent Y10-Y14 were extracted. Drugs involved are coded as T40.1(heroin), T40.2(natural and semisynthetic opioids), T40.3(methadone), T40.4(synthetic opioid other than methadone), T40.5(cocaine), T43.6(psychostimulants with abuse potential) in the ICD-10 multiple causes of deaths codes. T40.4, primarily illicitly manufactured fentanyls, contains fentanyl or fentanyl analogs, tramadols, and other synthetic opioids. We used linear regression to establish rates of change of illicitly manufactured fentanyl (IMF)-related overdoses between age/race subgroups over time and compared trends with Z-tests and non-parametric bootstrapping based on large sample theory. We utilized R 4.3.2 for analysis and Rshiny to create an interactive data visualization application (eWebApplication: https://r-shiny-exhibit-public.shinyapps.io/Overdose_Application/). The UTHSC IRB deemed this research exempt.

Results: Of 74,599 overdose deaths among 10-24-year-olds, 91.14% were unintentional. Since 2019, over 85% involved IMFs. The rate of IMF-related overdose deaths for AYA age 10-24 remains 50 times the rate in 2023 as it was in 1999, despite peaking at 9.28/100,000 in 2021 and subsequently decreasing. Other substance-related overdose mortality remained below 3/100,000 between 1999-2023.

IMF-related overdose fatalities remained stable across ages until 2013. Among 10-14-year-olds, they rose in 2017, increasing 580% between 2017-2022 and decreasing in 2023. 15-19-year-old IMF-related overdose fatalities increased by 1818% between 2014 and 2021, then down-trended from 2022 on. IMF-related overdose fatalities increased among 20-24-year-olds by 995% between 2014 and 2021 and decreased starting in 2022 .

20-24-year-olds experienced significantly faster increases in IMF-related overdose fatalities between 2014-2021 compared to other ages, with faster increases among 15-19-year-olds compared to 10-14-year-olds.

Before 2019, White AYA age 10-24 experienced the highest IMF-related overdose mortality compared to other racial and ethnic groups. In 2019, rates among American Indian/Alaska Native AYA (AI/AN) surpassed White AYA and have remained higher; rates increased significantly faster among AI/AN AYA overall compared to other groups and surpassed mortality rates of both White 15-19 and 20-24-year-olds in 2019, though rates in AI/AN 10-14-year-olds remained low over time. Starting in 2023, Fatal IMF-related overdoses among Latinx and Black AYA age 10-24 surpassed those of White AYA for the first time, after an 18.35% annual rate decrease among White AYA. Evaluated by age group, this shift was first seen in 2020 for Black and Latinx 10-14-year-olds, in 2019 for Latinx 15-19-year-olds, and in 2022 for Black 20-24-year-olds.

Conclusion & Discussion: US youth aged 10-14, 15-19, and 20-24 experienced increases in overdose fatalities in the past decade, mostly unintentional and involving IMFs. Recent decreases are not equal across race/ethnic groups; AI/AN AYA continue to experience the highest rates of IMF-related fatal overdose, and rates among Black AYA are increasing.

Our findings resonate with work highlighting IMFs’ impact in overdose fatalities among adults and adolescents and exposing racial/ethnic inequity in overdose fatalities. We expand upon prior studies by including ages 10-14, stratifying by age group, and evaluating long-term trends through 2023. Our findings are consistent with prior evidence of overdose fatalities among Latinx AYA aged 14-18 overtaking White fatalities in 2019 but differ from prior findings of higher White than Black/Latinx fatalities for 15-23-year-olds through 2021. We found higher rates earlier among younger racial/ethnic groups, suggesting higher disparity at younger ages.

Given overdose mortality burdens among all age subgroups studied, overdose prevention/response programming should be tailored and implemented to meet varying needs of youth of differing ages. Additionally, interventions must address disparities between racial/ethnic groups to promote equitable health outcomes.

References: 1. Goldstick JE, Cunningham RM, Carter PM. Current Causes of Death in Children and Adolescents in the United States. N Engl J Med. 2022;386(20):1955-1956. doi:10.1056/NEJMC2201761/SUPPL_FILE/NEJMC2201761_DISCLOSURES.PDF
2. Palamar JJ, Cottler LB, Goldberger BA, et al. Trends in characteristics of fentanyl-related poisonings in the United States, 2015-2021. Am J Drug Alcohol Abuse. 2022;48(4):471-480. doi:10.1080/00952990.2022.2081923
3. Friedman J, Godvin M, Shover CL, Gone JP, Hansen H, Schriger DL. Trends in Drug Overdose Deaths Among US Adolescents, January 2010 to June 2021. JAMA. 2022;327(14):1398. doi:10.1001/JAMA.2022.2847
4. Han B, Einstein EB, Jones CM, Cotto J, Compton WM, Volkow ND. Racial and Ethnic Disparities in Drug Overdose Deaths in the US During the COVID-19 Pandemic. JAMA Netw open. 2022;5(9):e2232314.
5. Friedman JR, Hansen H. Evaluation of Increases in Drug Overdose Mortality Rates in the US by Race and Ethnicity Before and During the COVID-19 Pandemic. JAMA psychiatry. 2022;79(4):379-381. doi:10.1001/jamapsychiatry.2022.0004