Opioid Overdose Risk Factors for Teens, College-Aged Youth Mirror Adults

Diagnoses of mental health and substance use disorders associated with three times higher odds of overdose.

11:00 AM

Author | Beata Mostafavi

Opioid adolescents image


Older teens may have similar risk factors for prescription opioid overdose as adults, a new study suggests.

One in 10,000 adolescents and young adults ages 12-21 overdosed while they had active opioid prescriptions – the same rate that's been reported for adult patients within 30 days of surgery – according to the findings published in JAMA Pediatrics.

And some adolescents and young adults may be particularly vulnerable – a mental health or substance use disorder was associated with a three times higher odds of opioid overdose.

Risk was also higher when patients took high amounts of opioid per day, took long-acting opioids such as OxyContin, and took opioids at the same time as benzodiazepines – central nervous system depressants frequently prescribed for anxiety, stress attacks and sleep disorders.

LISTEN UP: Add the new Michigan Medicine News Break to your Alexa-enabled device, or subscribe to our daily updates on iTunes, Google Play and Stitcher

The findings are similar to studies of overdose risk factors in older populations.

"Our knowledge of risk factors for prescription opioid overdose comes mostly from studies of middle-aged and elderly patients, particularly U.S. Veterans. There is little data about risk factors for overdose specifically in adolescents and young adults," says lead author Kao-Ping Chua, M.D., Ph.D., a pediatrician and researcher at Michigan Medicine's C.S. Mott Children's Hospital and the Susan B. Meister Child Health Evaluation and Research Center (CHEAR).

"Our findings suggest that clinicians can mitigate overdose risk in adolescents and young adults by using the lowest amount of opioid possible, relying on short-acting opioids, and avoiding the concurrent use of opioids and benzodiazepines."

Prior studies indicate that approximately 1 in 8 adolescents and young adults are prescribed opioids each year, and roughly 30% of the 3,000 opioid overdose deaths in this population during 2016 involved prescription opioids.

"These numbers highlight the importance of mitigating overdose risk when prescribing opioids to adolescents and young adults," says Chua, who is also a researcher at the University of Michigan Institute for Healthcare Policy and Innovation.

These numbers highlight the importance of mitigating overdose risk when prescribing opioids to adolescents and young adults.
Kao-Ping Chua, M.D., Ph.D.

Mental health and substance use disorders strong risk factors for overdose

Researchers analyzed national data for 2.8 million privately insured patients ages 12-21 who didn't have cancer and had opioid prescriptions between 2009 and 2017. Half of overdoses occurred among patients with a recent mental health diagnosis, and a quarter of overdoses involved patients with a substance use disorder, according to their analysis.

These risk factors are especially critical, Chua says, as an increasing number of young people are diagnosed with mental health conditions such as depression and anxiety, and as substance use disorders in this population are very common.

"Poor mental health is a growing crisis among youth," says Chua. "It will be increasingly important for clinicians to screen youth for mental health and substance use disorders before prescribing opioids."

MORE FROM MICHIGAN: Sign up for our weekly newsletter

When these disorders are present, Chua says, clinicians should consider additional risk mitigation steps such as co-prescribing naloxone, the opioid overdose antidote.

Safe opioid prescribing practices

The new research also focuses on the importance of avoiding concurrent prescriptions for opioids and benzodiazepines when possible. Previous research finds that young adults ages 18–29 report the highest rates of benzodiazepine misuse in the U.S.

"We know from prior studies that older patients are frequently prescribed opioids and benzodiazepines together," Chua says.

In our study, concurrent opioid and benzodiazepine use was relatively uncommon but was one of the strongest risk factors for overdose. It will be important to identify which clinicians account for concurrent opioid and benzodiazepine use in youth and why this concurrent use is happening." 

The study's findings also provide guidance for clinicians who are initiating opioid therapy in adolescents and young adults, and may also be useful for developing national opioid prescribing guidelines for youth, authors note.

"The safest approach may be to initiate opioid therapy using a short-acting opioid and the lowest potentially effective daily dosage," Chua says. "If needed, dosage can be slowly and carefully increased."

More Articles About: Rounds Drug Abuse and Misuse Medication Guidelines Post Operative and Recovery CS Mott Children's Hospital Pediatric Health Conditions Health Care Delivery, Policy and Economics Pharmacy
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories Drawing of parent trying to get child's attention who is listening to music on headphones
Health Lab
Are headphones and earbuds exposing your children to noise health risks?
2 in 3 parents in national poll say their child ages 5-12 use personal audio devices; pediatrician offers 4 tips to reduce noise exposure risks
Illustration of girl with blue water line, depicting a figure drowning, as girl contemplates pill in hand
Health Lab
Antidepressant dispensing to adolescents and young adults surges during pandemic
Rate of antidepressant dispensing to young people rose faster after March 2020, especially among females
Mom and daughter pose in two separate photos about 30 years apart. Daughter had a congenital heart issue, now is an adult.
Health Lab
Mother daughter duo reflect on nearly three decade heart journey
Mother, daughter reflect on congenital heart treatment and decades long treatment
Breaking Down Mental Health on blue background and text inside a yellow head graphic
Breaking Down Mental Health
Depression and Sleep
In this episode, learn to understand the interplay between depression and how cognitive behavioral therapy can improve sleep.
Scale pictured behind a hospital room curtain
Health Lab
Obesity care can make a big difference, but few get it, study suggests
Obesity care under a health care provider’s supervision, whether through nutrition counseling, medication, meal replacement or bariatric surgery, can help people with high BMI, but many don’t receive it.
Provider takes a pulse oximetry reading from a patient's finger
Health Lab
Inaccurate pulse oximeter readings could limit transplants, heart pumps for Black patients with heart failure
Racially biased readings of oxygen levels in the blood using pulse oximeters may further limit opportunities for Black patients with heart failure to receive potentially lifesaving treatments, such as heart pumps and transplants