During the Pandemic, Drug Overdoses Became the Third Leading Cause of Death for U.S. Adolescents

Authors

Colin Planalp, MPA, Senior Research Fellow at SHADAC

Tyler Winkelman, MD, MSc Co-Director, Health, Homelessness, and Criminal Justice Lab at Hennepin Healthcare Research Institute

Fatal overdoses involving fentanyl grew nearly 300% among adolescents

For roughly a quarter-century, U.S. drug overdoses have increased nearly every year. While this ongoing tragedy has surely harmed adolescents through the loss of parents and other loved ones, overdose deaths among U.S. adolescents remained relatively rare and changed little during most of the opioid crisis.

However, this changed when overdoses among adolescents began to increase during the COVID-19 pandemic. In this blog, we take a closer look at adolescent drug overdose deaths during the pandemic period, including examining specific substances that led to these deaths.

Drug Overdoses Third Leading Cause of Death in Adolescents in 2022

From 2019 to 2022, the rate of fatal drug overdoses among U.S. adolescents (age 13-17) more than doubled — increasing from 1.3 drug overdoses deaths per 100,000 adolescents to 3.2 drug overdose deaths per 100,000 adolescents. With that change, drug overdoses became the third leading cause of death among U.S. adolescents in 2022, following firearm injuries and transportation-related injuries (e.g., automobile collisions).

Figure 1. Top Causes of Death Among U.S. Adolescents, 2019-2022

Source: SHADAC analysis of NVSS mortality data
* Statistically significant increase in overdose rate at 95% level.

Description of Figure 1 found in alternative text.

Fentanyl and Related Synthetic Opioids Most Common Substances in Adolescent Overdoses

We also examined the specific substances most commonly involved in fatal overdoses to understand the key drivers of this large increase in deaths among adolescents.

Fentanyl and related synthetic opioids played the largest role in growing adolescent drug overdose death rates, increasing by 293% between 2019 and 2022. Stimulants also contributed to the growing death toll: Also between 2019 and 2022, fatal overdoses involving cocaine increased by 104% during, and fatal overdoses involving methamphetamine and similar “psychostimulants” increased by 87%. Each of those increases was statistically significant.

Among the most common categories of substances involved in fatal overdoses, only natural and semi-synthetic opioids [commonly referred to as prescription opioid painkillers (e.g., oxycodone, morphine)] held statistically steady, with no significant change.

Figure 2. Most Common Substances Attributed to Fatal Overdoses Among U.S. Adolescents, 2019-2022

Image

Source: SHADAC analysis of NVSS mortality data
* Statistically significant increase in overdose rate at 95% level.

Description of Figure 2 found in alternative text.

Adolescent Drug Overdose Deaths Warrant Attention and Solutions

The pandemic era marked an inflection point in the overdose crisis for adolescents, with drug poisonings rising to become one of the top three causes of death — more deadly than cancer. Given this development, the U.S. public health and health care systems need to urgently adopt strategies to mitigate the harm.

Effective approaches to reduce the harm of substance use and overdose among adults may not work for adolescents, whose substance use profile may differ. Interventions should be tailored to ensure adolescents aren’t overlooked by responses designed for adults. For instance, proliferation of trafficked counterfeit prescription pills, often containing fentanyl, may pose a unique risk for adolescents, who are more likely to misuse prescription medications than heroin.¹

The U.S. cannot afford to neglect this new development in the opioid crisis, which is killing adolescents at a historic and growing rate.

Learn more about the Opioid Epidemic in the United States here. You can continue to learn about drug and alcohol use or child and adolescent health in some of the following SHADAC products:

• Blog - What Are Adverse Childhood Experiences (ACEs)? ACEs Definition, Data Challenges, and Resources
• Brief - Sobering Statistics: Acceleration of Alcohol-Attributable Deaths Across the United States During the COVID-19 Pandemic
• Blog - Children’s Health Insurance in 2023: Exploring Rising Uninsured Rates for Low-Income Children