Drug-related deaths are on the rise in teens and young adults: What factors are related to this increased mortality?

The U.S. has seen a tragic increase in the number of drug-related deaths in the past 20 years. Adolescents and young adults have higher rates of illicit drug use than other age groups, yet little is known specifically about drug-related deaths among younger Americans. This study found significant increases in death rates attributable to some drug types (e.g., opioids, pharmaceuticals, and illicit drugs) in 15 to 24-year-olds in the 10-year span between 2006 and 2015, with the financial burden of drug-related deaths in this population estimated at approximately $35 billion nationally. This supports that drug-related mortality is a public health crisis among adolescents and young adults as well.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Adolescents and young adults are more likely to use drugs than their adult counterparts. While the overdose epidemic is well-recognized, there is limited data on the burden of drug-related deaths specifically in adolescents and young adults, as well as the sociodemographic factors that may increase risk. To address this need, Ali and colleagues examined rates of drug poisoning deaths among 15- to 24-year-olds in the United States from 2006 to 2015. They also examined how these trends varied according to key sociodemographic characteristics and the total costs associated with drug poisoning deaths in the age group. The ultimate goal of this research study was to determine the magnitude of the problem associated with drug-related deaths in adolescents and young adults and define factors that may inform more targeted prevention efforts.

HOW WAS THIS STUDY CONDUCTED?

Study authors used census data from the National Vital Statistics System’s Multiple Cause of Death files to determine the rates of drug-related deaths among 15- to 24-year-olds in the United States from 2006 to 2015. Drug-related deaths were classified according to the primary drug involved. Deaths related to alcohol use were not included in the current analyses. Trends were examined according to key sociodemographic characteristics including age (15-19 or 20-24 years), sex, race/ethnicity, region in the United States (Northeast, Midwest, South or West), urbanization level (metropolitan or nonmetropolitan), and intent of drug poisoning (unintentional, suicide, homicide, or undetermined). Finally, the medical, work productivity, and quality of life loss costs for each drug-related death were computed in a manner similar to previous work.

WHAT DID THIS STUDY FIND?

In adolescents and young adults between 2006 and 2015, there were 36,422 drug-related deaths.

Opioids were the primary drug involved in these deaths in nearly half of these cases, and the vast majority of drug-related deaths were unintentional (85%). Drug-related deaths increased by approximately 2% annually on average, with the steepest incline attributable to opioid-related overdoses.

Several sociodemographic factors predicted overall rates of and changes in adolescent and young adult mortality due to drugs. Rates of drug-related deaths were highest among:

Young adults vs. adolescents;
Males vs. females (though the sex gap narrowed over time);
White and American Indian/Alaska Native adolescents and young adults vs. Blacks, Asian/Pacific Islanders, and Hispanics;
Residents of the Northeast;
Residents in metropolitan areas.

The societal costs of drug-related deaths in adolescents and young adults were high, estimated at approximately $35.1 billion nationally in 2015, with medical and quality of life loss the largest contributors to the costs incurred.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

When different risk factors are considered in relation to the number of life–years lost due to disability or premature death in 15-24-year-olds around the world, alcohol remains the leading risk factor, and other drug use is in the top 10. Results from this study highlight a spike in opioid-involved overdoses among U.S. youth that is occurring in this larger context of long-standing risks attributable to alcohol and other drug use. The disproportionate role of opioids in mortality burden reflects the increased accessibility to seductive pharmaceutical opioids in this age group, which in turn increases the likelihood of subsequent use of even more potent and lethal opioids (e.g., heroin/fentanyl). Results from this study also support the notion that drug-related deaths may be more prevalent among members of different sociodemographic groups, most notably among young adults, males, and Whites and American Indian/Alaska Natives. Additionally, drug-related deaths were more prevalent among residents in metropolitan areas, particularly in the Northeast, consistent with the growing illicit drug market in these regions. Authors did not explore or speculate why these particular sociodemographic characteristics may be most robustly associated with drug-related deaths in adolescents and young adults. Future studies are needed to determine why these factors are so important in conferring risk, which can then be used to further inform more targeted prevention programming. Findings speak to the urgent public health priority of preventing and treating drug use early, with special attention to the individuals most vulnerable to negative outcomes.

LIMITATIONS

This study involved analysis of death certificate census data, which comes with known limitations including incomplete reporting.
States may have increased the rate at which they were testing those deceased for drugs, which may artificially appear as an increase in deaths attributable to drugs.
Many drug-related deaths involve more than one category of drugs (e.g., opioids and benzodiazepines); however, this study only analyzed the primary drug involved.
Analyses ended at 2015, precluding an understanding of more recent trends, such as the spike in fentanyl-related overdose deaths.
Analyses omitted alcohol-related deaths. Trends in alcohol-related deaths in this population are warranted, as well as identification of the sociodemographic characteristics that magnify risk.

BOTTOM LINE

For individuals and families seeking recovery: This national U.S. study of adolescent and young adults showed a 2% annual increase in drug-related deaths, largely attributable to opioids, with several key factors predictive of mortality. These included being male, older, White or American Indian, and a resident of a metropolitan area, particularly in the Northeast. This study demonstrates that misuse of drugs, particularly opioids, carries a risk of death even among young users. Because many youth believe pharmaceutical opioids are safer because they were once prescribed by a medical professional, and exposure to them can be seductive to the developing brain, youth should be screened for even low-level use and, if detected, addressed in the context of treatment to minimize further risks. Although this study focused on drug-related deaths, it is important to note that alcohol also contributes substantially to teen and young adult death and disability beyond drug-related deaths (e.g., via alcohol poisoning, motor vehicle accidents, impacts on emotional and cognitive functioning, etc.).
For treatment professionals and treatment systems: This study of adolescent and young adults showed a 2% annual increase in drug-related deaths, largely attributable to opioids, with several key factors predictive of mortality. These included being male, older, White or American Indian, and a resident of a metropolitan area particularly in the Northeast. Approximately 85% of drug-related deaths were unintentional. Therefore, all individuals using substances, particularly opioids, should be informed that death may be an unintended consequence of continued use. Findings point to key sociodemographic factors which may elevate risk for premature drug-related mortality, but clinicians should bear in mind that no young person who is using substances – particularly opioids – is immune to risk and treatment should aim to reduce harm among all users. Findings point also to large societal economic costs associated with drug-related deaths in adolescents and young adults, and thus reducing rates of use will have likely economic benefits at a societal level.
For scientists: Findings suggest that drug-related deaths in adolescents and young adults remain a public health, as well as economic priority, and highlight clear specific factors that elevate risk. Specifically, over a 10-year period there was a 2% annual increase in drug-related deaths – attributable largely to opioids – with several key factors predictive of higher mortality including being male, older, White or American Indian, and a resident of a metropolitan area particularly in the Northeast. Further research is needed to understand why such youth sub-groups are at elevated risk so that more targeted and tailored prevention and intervention efforts can be developed and implemented.
For policy makers: Findings suggest a 2% increase in drug-related deaths among adolescents and young adults, largely due to opioid use, with certain sociodemographic characteristics conferring greatest risk (being male, older, White or American Indian, and a resident of a metropolitan area particularly in the Northeast). Although more research is needed to understand the specifics of how exactly the predictors of elevated mortality risk identified in this study (e.g., being male) translate into such higher risk, these data may highlight state-level prevention and intervention planning. Specifically, in U.S. regions with the greatest mortality burden (e.g., in the Northeastern U.S.), policy makers might consider more aggressive implementation of interventions found to work in general, such as those aimed at reducing opioid prescribing practices (e.g., prescription drug monitoring programs; physician education), naloxone (e.g., Narcan) distribution programs, and safe needle and opioid medication disposal programs. Additionally, although beyond the focus of this particular study, more effective policy continues to be warranted with regard to teen and young adult alcohol use. Alcohol policies have been shown historically to reduce problematic alcohol use and associated health consequences in the population in general, but more specific attention is needed to address alcohol-related harms in the developmental context of adolescence and young adulthood.

CITATIONS

Ali, B., Fisher, D. A., Miller, T. R., Lawrence, B. A., Spicer, R. S., Swedler, D. I., & Allison, J. (2019). Trends in drug poisoning deaths among adolescents and young adults in the United States, 2006-2015. Journal of Studies on Alcohol and Drugs, 80(2), 201-210. doi: 10.15288/jsad.2019.80.201