Nonfatal overdoses linked to early substance use and family history in youth

Multi-state study finds opioid misuse and familial substance use strongly associated with overdose risk in adolescents and young adults

RESEARCH TRIANGLE PARK, N.C. — A new multi-sample study co-authored by experts at RTI International, an independent scientific research institute, has found that adolescents and young adults who misuse opioids or have family members with substance use problems are significantly more likely to experience nonfatal overdoses. The research, conducted across six U.S. states in legal, health care and child welfare settings, highlights urgent risk factors in the fentanyl era.

“This is the first study to examine nonfatal overdose correlates across multiple youth populations since the rise of illicitly manufactured fentanyl,” said Barrett Montgomery, Ph.D., a drug use epidemiologist at RTI. “We found consistent associations between overdose history and both opioid misuse and the number of family members with substance use problems.”

The study analyzed data from 1,856 participants aged 16 to 31, enrolled between 2020 and 2023 in opioid use disorder prevention programs funded by the National Institutes of Health’s HEAL Prevention Initiative. 

Across all samples, youth who had misused prescription opioids or used illicit opioids such as heroin or fentanyl were more likely to report a history of overdose. Early initiation of opioid use, defined as age 16 or younger, was also strongly associated with overdose history.

In addition to opioid misuse, frequent and early use of alcohol and cannabis emerged as notable risk factors. In several samples, youth who began using alcohol or cannabis before age 15 had significantly higher odds of reporting a nonfatal overdose. In some cases, every participant with an overdose history had also used cannabis, indicating a potential link that warrants further investigation.

“These are the first of many findings to come from this unique data resource which can give insights on the risk factors for opioid misuse and dependence among older youth and young adults from a variety of different backgrounds,” said Phillip Graham, DrPH, principal scientist at RTI. “RTI is excited to support its research partners to facilitate the integration of and access to a data source to address one of the most pressing public health crises.”

The authors recommend integrating overdose education into public health and clinical interventions for youth. They also call for standardized methods to assess nonfatal overdose experiences among adolescents and young adults to improve comparability across studies and settings.

The research was conducted in collaboration with investigators from Massachusetts General Hospital, Boston University, Boston Medical Center, University of Michigan, Seattle Children’s Hospital, Texas Christian University and Chestnut Health Systems.

Read the full study (via Drug and Alcohol Dependence)

Learn more about RTI’s substance use research