Incidence and Characteristics of Nonfatal Opioid Overdose Among Youths Aged 11 to 24 Years by Sex

This cohort study compares the sociodemographic and clinical characteristics of US youths who have experienced a nonfatal opioid overdose and examines the incidence of nonfatal opioid overdose by sex. Question Among youths who experience nonfatal opioid overdose, are there differences by sex in sociodemographic and clinical characteristics and incidence of occurrence? Findings In this cohort study of 20 312 commercially insured US youths aged 11 to 24 years who experienced nonfatal opioid overdose, female youths had a higher prevalence of baseline anxiety, depression, and history of self-harm; male youths had a higher baseline prevalence of other substance use disorders. Among those aged 11 to 16 years, female youths experienced a significantly greater incidence of nonfatal opioid overdose than male youths; after age 17 years, the incidence became greater for male youths than for female youths. Meaning This study found differences between female and male youths in sociodemographic and clinical characteristics and incidence of nonfatal opioid overdose, suggesting a need for tailored strategies to address overdose in this population. Importance Opioid-related overdose has substantially increased among adolescents and young adults in recent years. How overdose differs by age and sex among youths and the factors associated with overdose by sex remain poorly described. Objective To compare the sociodemographic and clinical characteristics of female and male youths who have experienced a nonfatal opioid overdose (NFOD) and compare the incidence of NFOD by sex. Design, Setting, and Participants This retrospective cohort study used data on US individuals aged 11 to 24 years with a diagnosis of NFOD from the IBM MarketScan Commercial Database from January 1, 2006, through December 31, 2017. Exposure Sex. Main Outcomes and Measures The primary outcome was NFOD stratified by sex; covariates included sociodemographic and clinical characteristics. Results Among 20 312 youths aged 11 to 24 years who had a history of NFOD and met study eligibility criteria, the median age was 20 years (interquartile range, 18-22 years; mean [SD] age, 20.0 [2.9] years) and 56.7% were male. Compared with male youths, female youths had a higher baseline prevalence of mood or anxiety disorder (65.5% vs 51.9%, P < .001), trauma and stress-related disorders (16.4% vs 10.1%, P < .001), and history of suicide attempt or self-harm (14.6% vs 9.9%, P < .001). Male youths had a higher prevalence of opioid use disorder (44.7% vs 29.2%, P < .001), cannabis use disorder (18.3% vs 11.3%, P < .001), and alcohol use disorder (20.3% vs 14.4%, P < .001). The incidence rate ratio of NFODs in females vs males was greater than 1 for ages 11 to 16 years and was less than or equal to 1 after age 17 years. Conclusions and Relevance This cohort study found differences between female and male youths in sociodemographic and clinical characteristics and incidence of NFOD. Although female and male youths who experience overdose appear to have different risk factors, many of these risk factors may be amenable to early detection through screening and intervention.