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Abstract

Article #1:Ali B, Fisher DA,Miller TR, et al.: Trends in drug poisoning deaths among adolescents and young adults in the United States, 2006–2015. Journal of Studies on Alcohol and Drugs 2019; 80(2), 201–210. Background: Drug use among adolescents and young adults (15 to 24-year-olds) is a serious public health concern in the US, with drug poisoning deaths one of the leading causes of death in this population. Unfortunately, there is limited research on the characteristics and trends of these adolescent poisoning deaths. Research Questions: What are the sociodemographic characteristics and state trends in drug poisoning deaths for US adolescents and young adults? And what are the estimated costs attributable to drug poisoning mortality in this population? Methods: The National Vital Statistics System’s Multiple Cause of Death files were used to analyze records of drug poisoning deaths among 15 to 24-yearolds in the US from 2006 to 2015. ICD-10 codes were used to identify drug poisoning deaths by the primary drug involved. Cases were then categorized into one of four drug categories: opioids (prescription or illicit), pharmaceutical drugs (excluding opioids), illicit drugs (excluding opioids), or unspecified drugs. Assessed sociodemographic variables included age (15–19 or 20– 24), gender, ethnicity, US census region, urbanization level, and intent for drug poisoning. Joinpoint regression analysis was performed to determine significant changes in drug poisonings over time. Costs of drug poisoning deaths were calculated based on estimated medical costs, lost work, and quality of life loss. Results: During the study period, 36,422 adolescents and young adults died of drug poisoning, with the death rates (per 100,000 population) increasing from 8.1 in 2006 to 9.7 in 2015 (an average increase of 1.8% per year; not statistically significant). Almost half (47%) of all deaths were attributed to opioids, and most (84.7%) were unintentional. Death rates were higher for those aged 20–24 years (13.0), male (12.0), Whites (11.9) and American Indian/Alaska Natives (10.0), and those living in the Northeast (9.4) or urban areas (8.5). There were significant increases in death rates for the following: opioid and pharmaceutical drugs, Whites, Asian/Pacific Islanders and Blacks, and those living in the Midwest and Northeast. The US drug poisoning death rate was 8.4 adolescents/young adults (per 100,000) but varied by state. West Virginia (15.1), New Mexico (14.7), and Nevada (13.5) had the highest rates. The overall cost of drug poisoning deaths was estimated as $35 billion in 2015. Conclusion: Drug poisoning death rates have increased significantly for many groups of adolescents and young adults in the US. Targeted efforts should be used to help prevent these deaths. Critique: This study had several limitations, based on the use of census data, including use of ICD-10 codes to identify drug poisoning deaths, varied use of drug testing by state to determine cause of death, and coding cases by the first reported drug (despite almost half of the cases reporting multiple drugs). Implication for Toxicologists: Toxicologists should understand the trends in drug poisoning deaths among adolescents and young adults, in their region, to help advocate for targeted prevention efforts.