Unintentional Drug Overdose Mortality in Years of Life Lost Among Adolescents and Young People in the US From 2015 to 2019

This cross-sectional study assesses the mortality among adolescents and young people in the US from 2015 to 2019 in years of life lost from unintentional drug overdose.


Unintentional Drug Overdose Mortality in Years of Life Lost Among Adolescents and Young People in the US From 2015 to 2019
Unintentional drug overdose has become a grave and sustained public health burden in the US. 1 The US Centers for Disease Control and Prevention (CDC) defines unintentional drug overdose as occurring "…when no harm is intended." 2(p1) and inclusive of "…overdoses resulting from drug misuse, drug abuse, and taking too much of a drug for medical reasons." 2(p1) Adult decedents have been the focus of most overdose mortality reports, despite the fact that adolescents (aged 10-19 years) and young people (aged 10-24 years) are increasingly dying of unintentional drug overdose. 3 This troubling trend requires further study, given that adolescents and young people are deprived of many more years of work, community life, and family life than are older individuals dying of unintentional drug overdose. To our knowledge, no prior study has assessed unintentional drug overdose mortality among adolescents and young people in years of life lost (YLL). YLL is an epidemiologic descriptor that gives weight to deaths among the young. 4 YLL analysis has the potential to provide important context to the overdose crisis by better representing what is meant to society by the loss of adolescents and young people to unintentional drug overdose. The present work aimed to fill this important gap in the literature by calculating unintentional drug overdose YLL in this vulnerable population.
Methods | This cross-sectional retrospective study involved summary-level death records from January 1, 2015, to December 31, 2019, obtained from the CDC's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) mortality file. 5 YLL were calculated as standard life expectancy mi-nus age at death. Male and female life expectancy at each individual age was determined from the 2017 Social Security Administration Period Life Table. Information on race and ethnicity was not gathered to protect the privacy of the individuals in the database. Decedents were identified by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes X40-X44. The Ohio State University Wexner Medical Center institutional review board approved this study and granted a waiver of patient consent owing to the use of deidentified patient data. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.
Results | A total of 3296 adolescents (aged 10-19 years) died of unintentional drug overdose in the US between 2015 and 2019 ( Figure). The mean (SD) age at death for adolescent unintentional drug overdose decedents was 15.  (Table). Adolescents experienced a total of 187 077.92 YLL during the study period.
A total of 21 689 young people (aged 10-24 years) died of unintentional drug overdose (Figure). The mean (SD) age at death for young people who died of unintentional drug overdose was 17.6 (4.  (Table). Young people experienced a total of 1 227 223.58 YLL during the 5-year period of study.
Discussion | Over the 5-year period of this cross-sectional study, adolescents experienced nearly 200 000 YLL, and young people amassed greater than 1.25 million YLL. Male adolescents and young people accounted for substantially greater unintentional drug overdose mortality (YLL and incident deaths)  Letters than female adolescents and young people. Although limited by death records potentially undercounting overdoses and a cross-sectional design insensitive to temporal relations between risk factors and deaths, our findings represent an unacceptable preventable mortality burden for adolescents and young people in the US. Prior research has identified polysubstance use, psychiatric comorbidity, and unstable housing as relevant risk factors for unintentional drug overdose in this age cohort. 6 Our findings suggest that further resources are needed to mitigate these factors. The present study should inform future mortality reviews among adolescents and young people, as well as ecologic interventions involving family, school, and community, in unintentional drug overdose prevention and substance use treatment.

Evaluation of Self-reported Cannabis Vaping Among US Youth and Young Adults Who Use e-Cigarettes
E-cigarette use, or vaping, has gained much public attention because of its rapidly increasing popularity among adolescents. 1 Besides its use for vaping nicotine, vaping devices, such as ecigarettes and vape pens, can be used to vape cannabis by heating a liquid or oil containing delta-9-tetrahydrocannabinol (THC). However, little is known about cannabis vaping, 2 and many people may mistakenly interpret vaping as just nicotine vaping. For example, EVALI (e-cigarette or vaping useassociated lung injury) was initially assumed by most investigators to be associated with nicotine vaping but was later found to be associated with vaping THC with vitamin E acetate as an additive. 3 However, after this finding was widely disseminated, most adults associated the EVALI deaths with the use of nicotine-containing e-cigarettes. 4 Thus, distinguishing nicotine from cannabis vaping is important. We used data from the Population Assessment of Tobacco and Health (PATH) Study 5 to identify the proportion of current e-cigarette users who vaped cannabis and their frequency of cannabis vaping, characterized by age and other sociodemographic variables.
Methods | The PATH Study 5 is a national longitudinal study of tobacco use among US adults and youth. A total of 11 356 young adults aged 18 to 24 years and 11 976 adolescents aged 12 to 17 years participated in the wave 5 survey, which was conducted from December 2018 to November 2019. The weighted response rates for the wave 4 cohort were 88.0% for adult and 83.5% for youth participants. We incorporated crosssectional survey weights to calculate nationally representative prevalence. Race and ethnicity data were self-reported. The University of Alabama at Birmingham Institutional Review Board exempted the present cross-sectional study from review and waived the requirement for patient informed consent because it used deidentified data. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
We assessed the frequency of cannabis vaping according to the categorical responses to the PATH Study survey question, "When you have used an electronic product, how often were you using it to smoke marijuana, marijuana concentrates, marijuana waxes, THC, or hash oils?" We also constructed a binary variable of cannabis vaping based on the answer "never" vs all other responses. We included only participants who reported past 30-day use (current use) of electronic nicotine products.
Pearson χ 2 test of independence was performed to assess the association between cannabis vaping and the sociodemographic variable. A P = .05 was used as the threshold for statistical significance. This complete case analysis used Stata, version 17 (StataCorp LLC), with the svy command to incorporate survey weights.