Post-overdose treatment gaps and prevention opportunities in a national population of high-risk youth

About This Grant

PROJECT SUMMARY Drug overdose is now a leading cause of death among U.S. adolescents and young adults, rising substantially in the past decade due to the proliferation of highly lethal fentanyl alongside other shifts in drug involvement. In parallel, nonfatal overdoses have risen in adolescents and young adults. Nonfatal overdoses greatly increase the risk of repeat overdose and subsequent death and have lasting consequences, especially life-threatening or near-fatal overdose events that may indicate greater need for behavioral health treatment and higher risk of future morbidity and mortality. Thus, nonfatal overdoses treated in acute care settings represent critical opportunities for intervention; however, limited data are available to inform discharge planning, with existing studies indicating an unmet need to improve connections to behavioral health treatment. Our overall goal is to generate evidence that can be used to tailor effective prevention and treatment strategies in the high-risk population of youth with a nonfatal drug overdose. To accomplish this goal, we will build on current work by the investigative team to study a critical developmental window from adolescence to young adulthood when the prevalence of illicit substance involvement in overdoes increases, risk factors may shift, and treatment options widen. We will capture a range of overdose types, including those that are nonfatal, near-fatal, and fatal; involvement of multiple illicit and commonly misused drugs as well as polydrug involvement; and events with suicidal intent in addition to unintentional overdose to improve understanding of the complex relationship of substance use and co-occurring mental illness. An extended study period from 2016-2025 will detect trends related to an evolving drug environment and changing levels of risk, and data linkages will integrate individual and clinically relevant predictors of overdose and death with health systems and other structural factors known to influence treatment delivery and health outcomes. We will focus on a sample of adolescents and young adults aged 12-29 years with initial drug overdoses treated in emergency department or inpatient settings. Specific aims are to: (1) assess trends in near-fatal and fatal overdose events from 2016-2025 by overdose type (drugs involved, intent) and age group (early/late adolescence, emerging/early adulthood); (2) identify behavioral health treatment trajectories in the six months after nonfatal overdose and differences by overdose type; and (3) quantify the one-year incidence of repeat overdose and all-cause mortality and develop a predictive model to ascertain modifiable risk factors contributing to these adverse outcomes. To achieve the aims, the study team will leverage national longitudinal Medicaid claims data (2016-2025) comprising an estimated 678,000 index overdose events in youth aged 12-29 years. Individual-level Medicaid data will further be linked with mortality, health system, and population data for a valid and timely approach to yield novel, generalizable, and up-to-date evidence on sentinel events and critical opportunities for intervention. Findings will fill a significant gap in research that is required to successfully target future overdose prevention and treatment strategies for adolescents and young adults.