Avik Chatterjee

Opioid-related overdoses and deaths remain a major public health concern in Massachusetts, yet adolescents who experience opioid-related nonfatal overdose have been rarely studied. Using public data, Brigham investigators recently unearthed several important ways in which the opioid crisis is playing out differently among young people versus adults.

Performed in collaboration with colleagues at the Boston University School of Medicine and Massachusetts Department of Public Health (DPH), the analysis examined data on Massachusetts adolescents, ages 11 to 17, who experienced an opioid-related nonfatal overdose between 2012 and 2014. In addition to understanding how prevalent these events were in young people compared to adults, researchers also found differences in how adolescents receive medication to treat opioid use disorder after experiencing a nonfatal overdose. The team’s results were recently published in Drug and Alcohol Dependence.

Among the findings were that adolescent girls were more likely to experience an opioid-related nonfatal overdose – the opposite of what has been observed in adults – although the reasons for this remain unclear. Additionally, investigators discovered these events were, overall, far less common in young people in the period studied, occurring in just under 200 adolescents versus more than 22,000 adults.

“This evidence will help guide the conversation about adolescent opioid abuse. In a lot of ways, this study raises more questions than answers, such as why more adolescent girls are overdosing than boys,” said Avik Chatterjee, MD, MPH, first author and associate epidemiologist in the Division of Global Health Equity at the Brigham. “The ability to bring attention to a population that has been understudied with regard to the opioid epidemic will help researchers and physicians explore ways to treat this epidemic in adolescence.”

‘An Opportunity to Intervene’

An opioid-related nonfatal overdose occurs when an individual uses an opioid, sometimes in conjunction with other drugs, and becomes mentally altered or sedated to the point that immediate, lifesaving treatment is necessary.

“A nonfatal overdose might be an opportunity to intervene,” said Chatterjee. “Individuals are using opioids so much that they are at risk of dying, so this could be a time when health care professionals could step in and help the person obtain treatment before a fatal overdose occurs.”

To examine the adolescent and adult rates in Massachusetts, researchers analyzed DPH data pooled from the entire state. This dataset represents 98 percent of Massachusetts residents and includes nonidentifiable medical information from hospitals, ambulance systems, substance-use systems, health insurance companies and homeless shelters.

“This analysis took advantage of a unique tool developed by the Massachusetts Department of Public Health to enable us to access linked, multiyear data for analysis of fatal and nonfatal opioid overdoses, as well as for other health priorities and trends,” said Dana Bernson, assistant director of Special Analytic Projects at the DPH. “These results highlight the importance of our partnerships with researchers from academic, nonprofit, private and government agencies in using data to respond to the opioid epidemic.”

Researchers were interested in examining whether adolescents received medication – methadone, buprenorphine or naltrexone – to treat an opioid use disorder within 12 months of experiencing a nonfatal overdose. They found that only 8 percent of adolescents were prescribed one of these medications within a year of the overdose.

The authors note that these numbers may be low because many people now have access to opioid overdose reversal drugs outside of a health care setting.

“This study demonstrates that the opioid epidemic is different in adolescents,” Chatterjee said. “This new knowledge will shape how we intervene and prevent opioid overdoses in adolescents.”

If you or someone you know would like to seek support for substance use disorder, contact the Addiction Recovery Program, an outpatient service in the Department of Psychiatry that helps patients with substance use disorder, at 617-983-7060, option 2.