Polysubstance Use in Youth Opioid Overdoses Rises with Age

Recent research highlights an alarming trend in youth overdose deaths involving multiple substances. While previous studies suggest that opioid overdoses with various drugs are common among individuals aged 25 to 54 in the United States, new findings from Boston University School of Public Health (BUSPH) and Mass General Brigham for Children reveal that polysubstance involvement in opioid overdoses is also significantly prevalent among younger populations. The study, published in the journal Pediatrics, examined data from 2020 to 2023 and found that overdose deaths among youth often involve more than just opioids. Interestingly, involvement with multiple substances begins at age 21 and is observed as early as age 15, with the proportion increasing steadily with age. Synthetic opioids, including fentanyl, were present in over 93% of overdose fatalities, while stimulants like methamphetamine and cocaine primarily contributed to polysubstance-related deaths.

According to Connor Buchholz, the study's lead author, these patterns indicate that the overdose crisis among individuals under 25 mirrors broader adult trends, marking a new, fourth wave dominated by the combination of stimulants and synthetic opioids. This shift follows previous waves driven by prescription opioids, heroin, and fentanyl. In 2023 alone, nearly 48.5 million Americans aged 12 or older experienced a substance-use disorder, with drug overdose deaths among adolescents doubling from 2018 to 2022. Despite a slight decrease in overdose deaths in 2024, the substantial rise underscores the urgency for targeted intervention strategies.

The study analyzed federal data and found that nearly half of the 23,000 youth overdose deaths involved multiple substances, with stimulants involved in 65% of these cases. The data showed that polysubstance-involved overdoses accounted for 25% of opioid deaths among 15-year-olds, rising to 58% among 24-year-olds. Aside from opioids, stimulants were the most common secondary substance involved, particularly among older youth.

While the research did not explicitly explore the causes behind the increasing involvement of multiple drugs, experts suggest factors such as greater availability of illicit substances, increasing drug potency, and worsening mental health among youth are significant contributors. Despite the decline in opioid prescriptions, youth remain at risk from counterfeit pills laced with fentanyl, and mental health issues heightened during the COVID-19 pandemic may lead more young people to turn to substances as coping mechanisms.

Concerns are further amplified by potential federal policy changes, including proposed cuts to Medicaid, which could limit access to essential treatments like buprenorphine, methadone, and naloxone—vital tools in preventing overdose deaths. Dr. Scott Hadland emphasizes that early intervention with developmentally appropriate, nonstigmatizing care is crucial to reducing overdose risks and long-term health consequences. Promoting widespread education on overdose prevention and expanding access to overdose-reversal medications such as Narcan are also vital components in tackling this evolving crisis.

For clinicians treating youth with substance use disorders, adherence to established guidelines is essential. Interventions may include off-label medication use, behavioral therapies, and contingency management to address stimulant use disorder. Overall, concerted efforts that focus on prevention, education, and accessible treatment are needed to reverse these troubling trends.

Source: https://medicalxpress.com/news/2025-08-polysubstance-involvement-youth-opioid-overdoses.html