Youth and Young Adult National Overdose Rates: A Descriptive, Ecological Cross-Sectional Time-Trend Analysis of Drug Overdose Mortality in 10-24-Year-Olds in the United States.

Introduction Drug overdose (OD) mortality continues to be a public health crisis in the United States (US). The ongoing fourth wave of the opioid crisis necessitates continued monitoring of contemporary drug OD trends, particularly among vulnerable populations, such as the youth and young adults (YYAs) aged 10-24 years old. Furthermore, the COVID-19 pandemic may have exacerbated the opioid crisis in this specific population, warranting further investigation. Thus, understanding the current dynamics of drug OD among YYAs can offer descriptive data to inform targeted intervention and resource allocation. As such, this ecological cross-sectional time-trend analysis aims to evaluate OD trends among those aged 10-24 years in the US from 2018 to 2023, with additional analyses focusing on region, race and ethnicity, and sex-specific trends. This study hypothesized that while OD death rates may have declined since the peak of the COVID-19 pandemic, current rates are still higher than pre-pandemic rates. Methods A primary query using the United States Centers for Disease Control and Prevention's (CDC) Wide-ranging ONline Data for Epidemiologic Research (WONDER) database yielded underlying cause of death data for those aged 10 to 24 years due to unintentional drug OD between 2018 and 2023. OD death rates per 100,000 were then analyzed by US geographical divisions and regions, race, ethnicity, and sex. For analysis, non-inferential, descriptive statistics were used. Crude OD rates were presented with 95% confidence intervals. Results Unintentional OD deaths peaked during the COVID-19 pandemic, and across the majority of the country, rates continue to be higher post-pandemic than pre-pandemic. Although the YYA OD death rate rose sharply between 2019 and 2020 from 6.6 [6.4-6.8] to 10.3 [10.1-10.6] per 100,000 individuals, the rate peaked at 10.5 [10.3-10.8] per 100,000 in 2021. While declining since 2021, the OD mortality rate remained higher in 2023 (8.3 [8.1-8.5]) than in 2018 (6.4 [6.2-6.6]) and 2019 (6.6 [6.4-6.8]). YYA males overall had higher rates of OD, yet the percent changes of OD death rates were higher among YYA females across most census divisions from the pre-pandemic period to the peri/post-pandemic period. Furthermore, American Indian and Alaska Native (AI/AN) YYAs were particularly impacted, with males and females experiencing an increase in OD death rate from 8.7 [7.0-10.7] pre-pandemic to 14.5 [12.8-16.1] peri/post-pandemic and 3.5 [2.4-4.9] pre-pandemic to 9.1 [7.7-10.4] peri/post-pandemic, respectively. Black or African American YYAs similarly exhibited an over twofold increase in crude OD death rate, from 5.5 [5.0-5.9] pre-pandemic to 13.2 [12.6-13.7] peri/post-pandemic for males, and from 2.5 [2.2-2.8] pre-pandemic to 6.2 [5.9-6.6] peri/post-pandemic for females. Conclusion Youth and young adults continue to be impacted by the ongoing opioid crisis and drug OD, highlighting an ongoing public health concern that must be addressed. Rates of unintentional OD deaths remain elevated above pre-pandemic levels despite decreasing since the peak of the pandemic. Addressing current OD trends among YYAs populations can maximize population-specific resource allocation, in hopes of reducing preventable, unintentional deaths among this vulnerable population.