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Opioids & SU
The Literature Collection contains over 11,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
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Objectives: Drug overdose (OD) deaths have been increasing over the past 20 years. Although risk factors for drug OD have been identified in adult populations, less is known about risk factors for OD in young people. The aim of this review is to systematically examine the literature to identify risk factors for drug OD specific to young people, including adolescents and young adults. Methods: Our initial PubMed search identified 4001 articles. Included were cross-sectional and longitudinal cohort studies published in English that compared young people who experienced a drug OD to those who did not. Review articles, meta-analyses, case-reports, editorials, epidemiological studies, and qualitative studies were excluded. Two investigators reviewed the full texts of all relevant articles and extracted data on sample demographics, prevalence of OD, and correlates associated with OD. Results: Twelve relevant studies were identified reflective of a sample of 5020 unique individuals with an age range of 14-30 years, and a mean age range of 20.2-26 years. The lifetime prevalence of OD in these young people ranged from 24% to 48%. Substance use characteristics most often associated with OD included injection drug, opioid, and tranquilizer use. Polysubstance use was also found to be strongly associated with OD in three studies. Other replicated risk factors for OD in young people included histories of psychopathology, incarceration, unstable housing, and witnessing an OD. Conclusion: Opioid, tranquilizer, and injection drug use have been identified as risk factors for OD in both younger and older adult populations. Risk factors that emerged as noteworthy predictors of OD in young people specifically include polysubstance use, psychiatric comorbidity, unstable housing, and witnessing an OD. There remains a paucity of literature on drug OD risk factors in young people, with little information regarding medical and treatment history risk factors.
IMPORTANCE: While a diverse array of cannabis products that may appeal to youth is currently available, it is unknown whether the risk of persistent cannabis use and progression to higher frequency of use after experimentation differs among cannabis products. OBJECTIVE: To estimate the comparative relative risk of experimental use of 5 cannabis products on use status and frequency of use among adolescents during 12 months of follow-up. DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, data were collected from 3065 adolescents at 10 high schools in southern California, with baseline data collected in spring 2016, when students were in 11th grade, and 6-month and 12-month follow-up surveys collected in fall 2016 and spring 2017, when students were in 12th grade. Analyses, conducted from April to June 2019, were restricted to 2685 participants who were light or nonusers of any cannabis product (ie, ≤2 days in the past 30 days) at baseline. EXPOSURES: Number of days of use of each cannabis product (ie, combustible, blunts, vaporized, edible, or concentrated) in the past 30 days at baseline (ie, 1-2 vs 0 days). MAIN OUTCOMES AND MEASURES: Past 6-month use (ie, yes vs no) and number of days of use in the past 30 days at 6-month and 12-month follow-ups for each product. RESULTS: Of 2685 individuals in the analytic sample, 1477 (55.0%) were young women, the mean (SD) age was 17.1 (0.4) years, and a plurality (1231 [46.6%]) were Hispanic individuals. Among them, 158 (5.9%) reported combustible cannabis use on 1 to 2 days of the past 30 days at baseline, 90 (3.4%) reported blunt use, 78 (2.9%) reported edible cannabis use, 17 (0.6%) reported vaping cannabis, and 15 (0.6%) reported using cannabis concentrates. In regression models adjusting for demographic characteristics and poly-cannabis product use, statistically stronger associations of baseline use with subsequent past 6-month use at the 6-month and 12-month follow-ups were observed for combustible cannabis use (odds ratio, 6.01; 95% CI, 3.66-9.85) and cannabis concentrate use (odds ratio, 5.87; 95% CI, 1.18-23.80) compared with use of blunts (OR, 2.77; 95% CI, 1.45-5.29) or edible cannabis (OR, 3.32; 95% CI, 1.86-5.95) (P for comparison < .05); vaporized cannabis use (OR, 5.34; 95% CI, 1.51-11.20) was not significantly different from the other products. In similarly adjusted models, we found the association of cannabis use at baseline with mean days of use at the 6-month and 12-month follow-ups was significantly stronger for cannabis concentrate than for other cannabis products; participants who had used cannabis concentrate on 1 to 2 of the past 30 days at baseline (vs 0 days) used cannabis concentrate a mean of 9.42 (95% CI, 2.02-35.50) more days in the past 30 days at the 6-month and 12-month follow-ups (P for comparison < .05). CONCLUSIONS AND RELEVANCE: Cannabis control efforts should consider targeting specific cannabis products, including combustible cannabis and cannabis concentrate, for maximum public health consequences.