- In a chart review of 127 young adults with substance use disorder who engaged with outpatient treatment, 8% had a nonfatal overdose during follow-up of up to 2.5 years
- The majority of overdoses occurred within the first year after initial evaluation
- A history of mood dysregulation and intravenous drug use were the most significant predictors of overdose
Individuals with substance use disorder (SUD) are five times more likely than those without to have a fatal overdose (OD). Community-based studies have identified important risk factors for OD in young people, including use of heroin, methamphetamine, tranquilizers or cocaine, but those findings may not generalize to young people who engage in SUD treatment.
Based on a systematic retrospective chart review, Amy M. Yule, MD, medical director for the Addiction Recovery Management Service, Tim Wilens, MD, chief of the Division of Child Psychiatry at Massachusetts General Hospital, and colleagues have found that, in young adults, the most significant predictors of OD after SUD treatment are a history of intravenous drug use or mood dysregulation. Published in The American Journal on Addictions, their report also pinpoints when they are most vulnerable to OD.
The researchers analyzed data on 127 patients, 16 to 26 years of age, who were evaluated for SUD at Mass General between January 2012 and June 2013 and subsequently engaged in outpatient treatment for SUD and any psychiatric disorders. Engagement was defined as attending at least two follow-up appointments within 30 days of the initial evaluation.
These patients were drawn from a cohort of 200 young adults whom Dr. Yule and others studied previously. Thus, 64% of eligible young adults engaged in treatment.
To examine differences between nonfatal and fatal OD, the researchers also reviewed the records of nine patients who had been treated in the same program at Mass General, although not part of the original study, and who fatally overdosed between November 2013 and August 2016.
Prevalence and Timing of OD
In the group of 127 patients, 8% had nonfatal ODs during follow-up of up to 2.5 years. There were no fatal ODs in that group. The vast majority of nonfatal ODs were unintentional (90%) and occurred within the first year after initial evaluation (90%), and most (70%) involved opioids.
Most of the nine fatal ODs (80%) also occurred within the first year after the initial evaluation. 50% of both nonfatal and fatal ODs occurred while the patient was still in treatment.
Characteristics Associated with OD
Patients who overdosed after receiving treatment were significantly more likely than those who did not overdose to have a lifetime history of:
- An opioid use disorder
- Intravenous drug use
- Mood disorder not otherwise specified
- Self-injurious behavior
A stepwise logistic regression model identified a history of mood disorder not otherwise specified and a history of intravenous drug use as the most significant predictors of OD after treatment. There were no differences between the nonfatal and fatal OD groups with regard to any SUD or psychiatric characteristic.
Applying the Findings
- Treatment reduces overdose risk—in a previous study this group found 29% of young people presenting for SUD treatment had a history of an overdose, and during treatment the prevalence of OD decreased to 8%
- Young people with SUD should be monitored closely during the first year after presenting for treatment
- Close monitoring is especially important for individuals with a history of mood dysregulation and characteristics of a more severe SUD, notably a history of intravenous drug use
- Young people with SUD are likely to have difficulty engaging in treatment, so developmentally informed care models are important in order to maximize engagement and retention
- Considering the association between mood dysregulation and OD risk in this study, young people with SUD should be assessed and treated for any co-occurring mood disorders
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