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Polysubstance Use Driving Overdose Deaths in Adolescents and Young Adults

Youth opioid overdose deaths increasingly involve cocaine and other substances rather than opioids alone, research finds.
prescription pills and other substances
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Combining opioid use with other drugs, known as polysubstance use, isn’t new. Data from the Centers for Disease Control and Prevention (CDC) in adults shows an increase in opioid overdose deaths involving other substances, including cocaine and methamphetamine, between 1999 and 2018. Now, a new study in JAMA Pediatrics demonstrates how prominent and fatal polysubstance use is specifically for adolescents and young adults — a group that has experienced a nearly three-fold increase in opioid-related mortality in recent decades.

Led by researchers at Boston Medical Center’s Grayken Center for Addiction, the study found that co-occurring substance use in young people has become the norm, not the exception.

“Our study provides significant insight into what is driving opioid-related overdoses among adolescents and young adults, which can help improve treatment and outcomes in this population,” says senior author Scott Hadland, MD, MPH, pediatrician and addiction specialist at Boston Medical Center.

The research and findings

Using cross-sectional data from the CDC’s Wide-Ranging Only Data for Epidemiologic Research, researchers looked at entries categorized as deaths involving multiple causes between January 1999 and December 2018 in youth aged 13 to 25 — specifically identifying deaths involving opioids such as fentanyl, heroin, and prescription pills. Entries categorized as opioid overdose deaths were further broken down by the presence of other substances, including benzodiazepines, alcohol, antidepressants, cannabis, antipsychotics, barbiturates, and cocaine and other psychostimulants.

"More than half of overdose deaths involved multiple substances, meaning that overdose deaths involving more than just opioids were more common than those involving opioids alone" Click To Tweet

During the study period, the rates of both opioid-only and polysubstance-involved opioid overdose deaths increased dramatically, by 384% and 760%, respectively. In 2018, there were 4,623 opioid overdose deaths among youth, with synthetic opioids most commonly involved (73%). Of those deaths, more than half (2,476) involved multiple substances — meaning that overdose deaths involving more than just opioids were more common than those involving opioids alone.

Cocaine and methamphetamine are the most common drugs in opioid overdose deaths in youths

Cocaine and other stimulants, such as crystal methamphetamine, are the most common other substances involved in opioid overdose deaths in youths, the study found. They contributed to more than a third of total overdoses and two-thirds of the polysubstance overdose deaths in 2018. The rate of opioid overdose deaths involving stimulants in this age group increased 351% between 2010 and 2018.

The findings underscore a growing awareness that effective approaches to treatment in the opioid epidemic may be more complex than prescribing medications for opioid use disorder alone (though it’s a good place to start). In order to address the national overdose crisis, special attention must be paid to adolescents and young adults, and interventions must factor in the growing use of stimulants and other substances with opioids.

“As providers, we need to recognize that co-occurring substance use disorders are common,” says Jamie Lim, MD, the study’s corresponding author, “and they must be addressed simultaneously when treating opioid addiction.”

Read Next: Meth, a Growing Presence in the Opioid Epidemic »

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Jenny Eriksen Leary


Jenny is the associate director of media relations at Boston Medical Center and has more than 15 years of experience in healthcare communications and public relations.