Nonfatal Drug Overdose in a National Sample of Adolescents by Intent and Substance, Medicaid 2016-2020

To estimate the prevalence and patterns of drug overdoses in adolescents presenting to an inpatient or emergency department setting by substance and intent in a national sample of Medicaid enrollees.

National Medicaid administrative claims data covering publicly insured adolescent (12-18 years old) enrollees from 2016 to 2020 were analyzed. Drug overdose was defined by an inpatient or emergency department poisoning code (ICD-10-CM T36-T50) for intentional, unintentional, or undetermined intent. Per calendar year, we estimated the prevalence of adolescents with a drug overdose among all eligible adolescent enrollees (≥10 months enrollment) overall and by patient demographics, intent, and substance involvement.

The annual sample of eligible adolescents ranged from 8.9 million (2016) to 10.9 million (2020). The average annual prevalence of any treated drug overdose was 0.41%, with minimal variation from 2016 (0.42%) to 2020 (0.40%). Prevalence varied by intent (intentional: 0.28%; unintentional: 0.17%, undetermined: 0.04%), sex, age, race and ethnicity, and, foster care status. Among adolescents with any intentional overdose claim, nonopioid analgesics (35.7%), antidepressants (21.6%), antipsychotics (9.8%), benzodiazepines (4.9%), and antiepileptics and other sedatives (6.0%) were most commonly involved. Cannabis (9.3%), benzodiazepines (8.4%), opioids (6.1%), and stimulants (5.2%) were more often involved in adolescents with any unintentional overdose claim. From 2016 to 2020, unintentional overdoses increased involving opioids (from 0.009% to 0.015%) and cannabis (from 0.012% to 0.017%).

While the prevalence of treated drug overdose was relatively stable from 2016 to 2020 among adolescent Medicaid enrollees, important patterns by substance, intent, and demographics were identified that will be key to reducing overdose morbidity and mortality in this young population.

This national study of adolescents enrolled in Medicaid estimated the annual prevalence of treated nonfatal drug overdose to be 0.41%, which varied by intent (0.28% intentional, 0.17% unintentional) and enrollee demographics. From 2016 to 2020, unintentional overdoses increased involving opioids (from 0.009% to 0.015%) and cannabis (from 0.012% to 0.017%). These patterns could potentially inform efforts to reduce adolescent overdose mortality.