(B-241) Prevalence of Adolescent Drug Overdose by Drug Involvement and Intent in U.S. Medicaid, 2016-2020

Background: Drug overdose is a leading cause of adolescent morbidity and mortality in the U.S. However, limited data exist on the prevalence of overdoses by drug involvement and intent in the adolescent population.

Objectives: To estimate the prevalence of hospital or emergency department-treated overdose by substance and intent in the adolescent Medicaid population.

Methods: The study used national Medicaid data from 2016-2020 and included adolescents aged 12-18 years with ≥10 months of enrollment and full benefits during that calendar year. Drug overdoses treated in inpatient or emergency department settings were identified with ICD-10-CM codes (T36-T50) and categorized by substance (e.g., opioids, stimulants, cannabis, psychoactive medications) and intent (intentional, unintentional, undetermined). The annual prevalence of any drug overdose was estimated and stratified by substance and intent.

Results: The sample included 8.9 to 10.9 million eligible adolescents per year and 37,017 to 43,042 adolescents with any hospital-treated drug overdose each year. The average annual prevalence was 0.41% for any drug overdose, 0.28% for intentional overdose, and 0.17% for unintentional overdose.

Among adolescents with intentional overdose across all years, involvement of non-opioid analgesics was most common (37.1%), followed by antidepressants (22.5%), antipsychotics (10.2%), benzodiazepines (5.2%), and other sedatives/antiepileptics (5.3%). From 2016-2020, the annual prevalence of intentional overdoses remained stable, with shifts by drug including declines in adolescents with opioid- and benzodiazepine-involved overdoses and increases in antidepressant-involved overdoses.

Among adolescents with unintentional overdose, involvement of non-opioid analgesics was most common (15.0%) across all years, followed by cannabis (9.5%), benzodiazepines (8.4%), antidepressants (7.8%), opioids (6.1%), and stimulants (5.3%). The largest absolute increase in prevalence was for unintentional opioid overdose from 2016 (0.009%) to 2020 (0.015%). While they remained low, the prevalence of unintentional overdoses involving natural/semi-synthetic (0.004% to 0.009%) and synthetic (0.001% to 0.003%) opioids doubled during this period.

Conclusions: Psychotropics and non-opioid analgesics are frequently involved in drug overdoses in the adolescent Medicaid population. While the prevalence of hospital-treated drug overdose was stable from 2016-2020, there were important shifts in drug involvement, including opioids in unintentional overdoses. These changing patterns can help inform targeted prevention and treatment strategies to reduce rising adolescent drug overdose mortality.