October 24, 2018

Risk Factors for Overdose in Youth With Substance Use Disorders

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Rachael Lyons, BS, and Amy Yule, MD

Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts​


In the past 15 years, a substantial increase in fatal and nonfatal overdoses (OD) has occurred in the United States, drawing attention to risk factors associated with OD. Although a growing literature has emerged regarding risk factors for OD in the general population, less research has focused on risk factors associated with OD in youth. Because substance use tends to begin during adolescence and peak in prevalence among emerging adults, it is important to consider OD risk factors specific to this age group. The study we conducted with our colleagues was the first to focus specifically on OD risk factors in treatment-seeking youth with substance use disorders (SUD).

We conducted a systemic retrospective medical chart review of consecutive intake assessments completed between 2012 and 2013 in an outpatient SUD treatment program for youth aged 16 to 26 years. We examined OD prevalence as well as substance use and psychiatric characteristics associated with a history of OD. The 200 patients included in the sample had a mean age of 20 years, and nearly 30% had a lifetime history of an OD. Of those who experienced an OD, 62% reported the OD was unintentional, and 41% had a history of multiple ODs.

Patients with an alcohol, cocaine, or amphetamine use disorder were significantly more likely to have a history of OD. Patients with characteristics of a more severe SUD, including history of intravenous drug use, blackouts, and receipt of medication to treat a SUD, were also significantly more likely to have experienced an OD. Psychiatric characteristics significantly associated with a history of OD included depressive, anxiety, or eating disorders, as well as history of self-injurious behavior, a prior suicide attempt, psychiatric hospitalization, or emotional, physical, or sexual abuse. When the substance use and psychiatric characteristics that were significantly associated with OD history were compared, a history of an alcohol use disorder, eating disorder, blackouts, intravenous drug use, and psychiatric hospitalization were the most significant predictors of OD.

Our work highlights the early presentation and high prevalence of OD in treatment-seeking youth with SUD as well as the influence of psychopathology on OD risk. Moreover, these newly identified risk factors for OD in young people with SUD should be considered by physicians treating young people. Continued research is important to gain increased insight into psychiatric and substance use characteristics proximal to OD.

Financial disclosure:Dr Yule is a consultant for Gavin House and has received grant/research support from the National Institutes of Health. Ms Lyons has no relevant personal financial relationships to report.

Category: Substance Use Disorder
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