Characteristics of Adolescents and Young Adults Who Died of Overdose: Opportunities for Intervention

Figure 1: Flow diagram of AYA decedents included in analysis.Opioid overdoses are the third leading cause of death for adolescents across the United States.1 Adolescents and young adults (AYA) who die of an overdose often have health care encounters in the week prior to their deaths. A study from Ontario showed that 25% of this population had seen a provider in the week prior to their death, highlighting an opportunity to intervene.2 This work uses a combination of databases to describe AYA (ages 12-24) who died of an overdose and their recent health care exposures. We combined data from the County Medical Examiner on AYA overdose from 2018 to 2024 with medical records data from the University of Washington (UW) to better characterize these patients. There were 386 deaths from overdose in AYA during the study period. Of these, 138 (36%) had been seen at UW, and 117 (30%) had been seen within the last 5 years. This is the population that was analyzed. Of those 117 patients, 39 (33%) had been seen within the month prior to their overdose deaths. Twenty (17%) had been seen within 3 days of dying, and an additional 5 (4%) were seen between 4 and 7 days preceding their death. In total, 25 (21%) of AYA were seen within the 7 days leading up to their overdose death. The majority of patients were male (68%), and overdose deaths were more common in older age groups than younger age groups. Patients who were Black and Native American were over-represented in this cohort relative to the population of the county. Patients who were Asian and Hispanic were under-represented in this group. The majority (62%) of deaths occurred in a private residence. This finding is consistent with national data, where 60% of deaths occurred at the decedent's home. In that larger report, potential bystanders were present 67% of the time, yet naloxone was only given in 30% of overdoses.3 In this smaller data set, fentanyl was present in 77% of cases, followed by methamphetamine (22%) and other opioids in 9.3% of cases. Over half of the clinical notes were written by the emergency department. Fifty-three percent (62/117) of deceased patients had a social worker note, and 16% (19/117) had a psychiatry note during their last visit. In those visits, 40% of drug screens that were performed were negative. Thirty-two of the 117 (27%) of deceased AYA patients got take-home naloxone at their last visit and 3/117 (2.5%) got buprenorphine. Combining these data sets provides new insight into overdose deaths in the AYA population. These data are similar to the findings in Ontario. It is clear that there are critical opportunities to intervene in this high-risk population that are being underutilized. Tools need to be developed to better understand which patients are at risk for an overdose. Adolescents are the age group that is least likely to receive bystander naloxone in the event of an overdose, and are also the least likely to get a prescription for buprenorphine relative to other age groups.3-4 Understanding risk and use profiles would allow timely implementation of appropriate treatments to decrease mortality risk by tailoring interventions to meet the need. For example, AYA patients who have no personal use of opioids but are in environments that contain them (home, schools, parks, etc) could benefit from naloxone distribution. Patients who have risky use of other nonopioid substances, like stimulants or benzodiazepines, could be aided by naloxone and fentanyl test strip provision. People who have true opioid use disorder would benefit from naloxone and medications for opioid use disorder. We can learn how to deploy interventions more intelligently in order to avert some of these tragic outcomes.Figure 2: Analysis of how recently decedents were seen by a health care provider before their death.However, we must not let “perfect” be the enemy of “good.” We already have the tools to substantially decrease the mortality from this disease. The fact that a classroom's worth of AYA die from this every week calls for action now. For a significant minority of the patients who will die of an overdose, we in the emergency department are their last chance at treatment. Emergency practitioners should be talking to adolescents about their drug use, especially when they present with a mental health complaint. Any adolescent who arrives intoxicated with any substance is a good candidate to take home naloxone, protecting them and equipping them to help family and peers. AYA patients who are using stimulants, benzodiazepines, or anything that comes as a pill or a powder could benefit from fentanyl test strips to decrease the risk of an inadvertent fentanyl exposure. Finally, AYA patients who are experiencing harm from repeated opioid use deserve access to buprenorphine. This medicine is safe to prescribe from the emergency department in adolescents, is effective at keeping them engaged in care, and it is life-saving.5-6 It is an opportunity to profoundly affect the life trajectory of a young person, and one that we need to embrace.