Majority of U.S. youth overdose deaths from 2018 to 2022 were driven by fentanyl alone
Study reveals changing nature of U.S. drug supply
(New York, NY) Fatal drug overdoses among youth aged 15 to 24 in the United States involving synthetic opioids alone—not mixed with other substances—soared by 168 percent over the five-year time period of 2018 to 2022, a new study shows. Published online May 20 in the journal Pediatrics, the work also found that youth overdose rates and drug combinations varied significantly across age, sex and race/ethnicity.
Led by NYU Grossman School of Medicine, the new study is the first, say investigators, to identify which specific combinations of drugs drove synthetic opioid-involved fatal overdoses among young people across sociodemographic groups over time.
Overdoses that involved synthetic opioids alone—predominantly fentanyl—had the highest rates of fatalities when compared to overdoses involving other drug combinations examined by the researchers. This was regardless of age, sex and race/ethnicity.
“Before we looked at the data, we thought we would find that the majority of fatal youth overdoses involved fentanyl combined with other substances, such as prescription opioids or cocaine,” said Noa Krawczyk, PhD, assistant professor in the Department of Population Health, and senior author of the study. “Instead, we found the opposite—that most deaths were caused by fentanyl alone. Our analysis sheds light on the changing nature and risks of the drug supply and how they impact key demographic groups. Some may think they are taking one substance but are actually exposed to another.”
According to Krawczyk, who is also associate director of the Center for Opioid Epidemiology and Policy at NYU Langone, their findings underscore the need to tailor overdose prevention strategies that include harm reduction services specifically to youth to prevent death and suffering among this under-studied population.
How the Study was Conducted
Analyzing data from the National Center for Health Statistics, the researchers characterized trends in overdose death involving synthetic opioids (predominantly fentanyl) alone, as well as in combination with five common other drugs (benzodiazepines, heroin, prescription opioids, cocaine, and other stimulants) among youth aged 15-24 across age, sex and race/ethnicity over five years (from 2018 to 2022).
The investigators found that during the five-year study period, overdoses involving synthetic opioids alone increased by 168 percent—the highest rates of fatalities compared to those that included a combination of the examined drugs, regardless of age, sex and race/ethnicity.
After deaths due to synthetic opioids/fentanyl alone, the next highest rates of fatal overdoses involved fentanyl combined with cocaine or another stimulant; however, rates differed by age, sex, race/ethnicity and over time. In 2018, White non-Hispanic youth had the highest rates of overdoses involving synthetic opioids/fentanyl alone. By 2022, rates of overdose deaths involving only fentanyl among Black American, American Indian and Alaska Native, and Hispanic youth exceeded White non-Hispanic youth. When it came to the impact of sex and age, fatal overdoses across all groups were highest among males, as well as all youth aged 20 to 24.
According to the research team, understanding the landscape of overdose patterns provides needed context in terms of how to best inform specific public health interventions that can prevent more deaths.
Megan Miller, a research coordinator at the NYU Center for Opioid Epidemiology and Policy and lead author of the study, emphasized that “there are a variety of ways to engage youth and reduce their risk of overdose. Schools, places of employment, homeless shelters, child welfare services, and juvenile justice settings are all possible touchpoints to offer education and harm reduction tools such as naloxone and fentanyl test strips. Our findings highlight the need to tailor these strategies to different youth groups based on the types of drugs they are using to help prevent further overdose deaths.”
Limitations to the study findings, according to the investigators, include possible misclassification in mortality coding practices, as well as limited sociodemographic information. For example, youth who identify as LGBTQ+ tend to have a higher risk of overdose, yet that information was not available. Due to small sample sizes, the data did not examine youth who may identify as more than one race or ethnicity.
In addition to Krawczyk and Miller, study co-authors from NYU Grossman School of Medicine include Katherine Wheeler-Martin, MPH, Amanda M. Bunting, PhD, and Magdalena Cerdá, DrPH.
Funding for the study was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number K01DA055758. Dr. Bunting was supported by the National Institute on Drug Abuse under Award Number K01DA053435. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
About NYU Langone Health
NYU Langone Health is a fully integrated health system that consistently achieves the best patient outcomes through a rigorous focus on quality that has resulted in some of the lowest mortality rates in the nation. Vizient Inc. has ranked NYU Langone No. 1 out of 115 comprehensive academic medical centers across the nation for three years in a row, and U.S. News & World Report recently placed nine of its clinical specialties among the top five in the nation. NYU Langone offers a comprehensive range of medical services with one high standard of care across seven inpatient locations, its Perlmutter Cancer Center, and more than 320 outpatient locations in the New York area and Florida. With $14.2 billion in revenue this year, the system also includes two tuition-free medical schools, in Manhattan and on Long Island, and a vast research enterprise.
Journal
PEDIATRICS
Subject of Research
People
Article Title
Changes in Synthetic Opioid–Involved Youth Overdose Deaths in the United States: 2018–2022
Article Publication Date
20-May-2025
Urban areas have higher rates of high-dose opioid prescriptions
Male middle-aged patients most likely to be prescribed a high dose of opioid prescriptions
University of Missouri-Columbia
Researchers from the University of Missouri School of Medicine have shed light on what populations are more likely to be prescribed a high dose of opioid medication. This increases their risk of developing opioid use disorder.
Opioids like hydrocodone or oxycodone are typically prescribed to relieve intense pain. A prescription can become an addiction; side effects include building a tolerance to the medication – so the patient has to take a higher dose to feel relief – or becoming physically dependent on the drug. These effects can happen quickly, even when taking opioids as prescribed.
“Many factors increase the risk of developing opioid use disorder,” study author Mirna Becevic said. “These include the severity of pain itself, how long opioids are used, their dosage and other medical conditions, such as neurologic or mental health disorders.”
To determine the populations most at-risk, Becevic and her team combed through over 3 million records of Medicaid claims in Missouri from 2017 to 2021. The study had a total of 306,432 observations, which was compared against 2018 USA census data and data from 2020 detailing the primary care shortage.
Becevic and her team found that male patients and people in the middle age range up to 60 years old were more likely to be prescribed a high dose of opioids. They observed a more conservative prescribing pattern for younger adults, which may be because of increased awareness about the opioid epidemic.
“Incidence of chronic pain increases with age, which may have affected the prescribing patterns we saw,” Becevic said. “Interestingly, the risk of prescription past age 60 sharply declined, though this could be because of the increased risk of adverse effects and potential drug interactions.”
Researchers also determined that areas with the largest risk of high-dose opioids correlated with areas that tended to be more urban and had higher percentages of veterans and primary care providers.
“These findings emphasize the need for public health strategies to address the opioid crisis,” Becevic said. “Opportunities are available for clinicians interested in learning more about evidence-based treatment for pain and opioid use disorder, including our Show Me ECHO program.”
While current clinical guidelines say high-dose opioids prescriptions should be avoided, it remains a common practice in certain areas. Since the study used only Missouri data, Becevic says the findings may not be relevant to other populations in the United States.
“Other states and regions have their own unique demographics, policies and health care access,” Becevic said. “Further studies should investigate long-term trends and why doctors prescribe high-dose opioids. Our study’s findings, however, help identify risk factors for all Missouri patients.”
Mirna Becevic, PhD is an assistant professor of dermatology at the MU School of Medicine. Her research focuses on telemedicine and telehealth.
“Identifying high-dose opioid prescription risks using machine learning: A focus on sociodemographic characteristics” was recently published in the Journal of Opioid Management. In addition to Becevic, MU study authors include Olabode Ogundele, PhD, with the Institute for Data Science and Informatics and the Missouri Telehealth Network; Butros Dahu, PhD, with the Institute for Data Science and Informatics; Praveen Rao, PhD, associate professor of electrical engineering and computer science; Xing Song, PhD, assistant professor of Biomedical Informatics, Biostatistics and Medical Epidemiology; Timothy Haithcoat, PhD, assistant teaching professor of Data Science and Analytics; and Tracy Greever-Rice, PhD, Director of the MU Center for Health Policy. Other authors include Mutiyat Hameed, from SSM Health, and Douglas Burgess, MD, assistant professor of psychiatry at University of Missouri – Kansas City.
Journal
Journal of Opioid Management
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Identifying high-dose opioid prescription risks using machine learning: A focus on sociodemographic characteristics
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