Informing national overdose prevention and treatment strategies for high-risk adolescents

PROJECT SUMMARY
Drug overdose is now a leading cause of death among U.S. adolescents, with mortality increasing in recent
years with the proliferation and involvement of illicitly manufactured fentanyl (IMF). In parallel, nonfatal
adolescent drug overdoses treated in emergency department (ED) settings have also increased. In contrast to
fatal overdoses, nonfatal overdoses mainly involve non-opioid drugs, including psychostimulant and other
psychotropic drugs that adolescents may use with a prescription or misuse from illicit sources with high risk of
IMF adulteration. To reduce morbidity and mortality from adolescent drug overdose, we need to better
understand the epidemiology of specific drug involvement in nonfatal overdoses, focusing on drugs commonly
containing IMF. Overdoses treated in acute care (ED) settings represent critical opportunities for risk assessment
and intervention, as mortality is significantly elevated in the period after a nonfatal event. However, limited
research suggests that receipt of comprehensive behavioral health care after overdose is exceedingly low in
adolescents, related to the lack of pharmacological treatments for substance use disorders, limited access to
developmentally appropriate behavioral therapies, and high rates of co-occurring mental illness and suicide
symptoms that complicate treatment decisions. Thus, we need to address the large gaps in evidence on the type
and timing of treatment adolescents receive following a nonfatal overdose and understand the relationship
between follow-up care and risk of repeat overdose. To generate evidence that can be used to inform effective
prevention and treatment strategies, this proposal’s overall goal is to identify individual and clinical care factors
associated with adolescent overdose risk. The specific aims are to: (1) estimate the prevalence of adolescent
nonfatal drug overdose and identify high-risk demographic and clinical subgroups, stratifying by drug involvement
(e.g., fentanyl) and overdose intent; (2) examine receipt of behavioral health treatment (type, timing) after
nonfatal drug overdose and variation in treatment receipt by demographic and clinical characteristics; and (3)
estimate incidence, critical high-risk periods, and risk factors for repeat overdoses, including the relationship with
behavioral health care received after the initial event. Our central hypothesis is that drug overdose patterns differ
by adolescent characteristics (e.g., sex, age group, mental health diagnoses) and that follow-up care is limited
but impacts the risk of repeat overdoses. To achieve these goals, the study team will leverage national
longitudinal Medicaid claims data (2016-2022) comprising over 400,000 overdose events in adolescents aged
12-18 years. Our proposal offers a valid and timely approach to yield novel, generalizable, and up-to-date
evidence on overdose risk and treatment in a vulnerable adolescent population. Findings will generate actionable
estimates to inform targeted prevention and treatment strategies as well as a future R01 application to integrate
health systems and structural factors in research on the effectiveness of behavioral health treatment modalities
on reducing risk of subsequent fatal and nonfatal overdose events.

Grant Number: 1R21DA062273-01
NIH Institute/Center: NIH
Principal Investigator: Greta Bushnell