Cross sectional multi-sample study of nonfatal overdose in adolescents and young adults in the fentanyl era

Overdose deaths disproportionately increased among adolescents and young adults (AYA) between 2019 and 2022, despite declining substance use. We examined the prevalence of nonfatal overdose and characteristics associated with overdose history in AYA.

AYA enrolled between 2020 and 2023 in five opioid use disorder prevention studies in child welfare, healthcare, and legal settings from six states were included in this analysis. Nonfatal overdose history, demographic, and clinical characteristics were assessed at baseline. Across studies, overdose history was assessed with slight variations in wording, but most other measures were standardized. Odds ratios (OR) of lifetime overdose were calculated with logistic regression for each risk factor with demographic control variables (age, sex, race) included as covariates, and reported separately by sample.

Sample sizes ranged from 137 to 929 (total N = 1856). Characteristics across samples ranged from M = 16.2-26.4 years for age, and 11.7-91.9 % for female sex. For race, samples ranged from 35 % to 89.4 % White and 17.3-89.4 % Black. History of nonfatal overdose ranged from 6.6 % to 41.4 %. Statistically significant characteristics associated with overdose history in all samples included history of opioid misuse (ORs ranging from 1.98 to 6.73) and family members with a substance use problem (ORs range from 1.27 to 2.05). Frequent and early onset alcohol and cannabis use was also associated with overdose history in several samples.

Overdose prevention interventions for AYA should include a focus on AYA who misuse opioids and families with a history of substance use problems.