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Drug overdoses, especially with stimulants, are on the rise among children, teens, and young adults, according to an analysis of emergency department (ED) data.

From 2016 through 2019, the proportion of youth presenting to the ED with a chief complaint of an all-drug overdose increased a mean 2% per quarter among children ages 10 and under, 2.3% for youth 11-14 years, and remained relatively stable among adolescents 15-24 years, reported Douglas R. Roehler, PhD, of the National Center for Injury Prevention and Control of the CDC in Atlanta, and colleagues.

Suspected stimulant overdoses rose by a mean 3.3% per quarter among children 10 and under, 4% among children 11-14, and 2.3% for older adolescents, they wrote in .

"Researchers have been seeing a rise in deaths involving stimulants since at least 2016," Roehler told 乌鸦传媒 in an email. "Those studies found this for youth 15-24 years of age, so it was striking to see nonfatal stimulant overdoses among our youngest populations."

Incidence of heroin overdose, however, decreased by a mean 3.3% per quarter for youth ages 15-24 years and remained very low in all other age groups, Roehler and co-authors reported.

Overall, the absolute number of overdoses for all drugs was small, at 22 events per 10,000 ED visits for the youngest children, 43 per 10,000 for 11- to 14-year-olds, and 85 per 10,000 for adolescents, they noted. Most overdose rates for specific drugs were even smaller.

"Despite the rarity of these suspected overdoses and given the age of these patients and the likely unintentional nature in many of these cases, efforts to halt these increasing trends are important," the authors wrote.

The fourth "wave" of the opioid epidemic has in part been driven by an increase in overdose fatalities involving stimulants like cocaine and methamphetamines, commented Scott E. Hadland, MD, MPH, of Boston University, and Brandon D.L. Marshall, PhD, of Brown University in Providence, in an

Many of the drug classes involved in youth overdoses are commonly prescribed for treating attention deficient-hyperactivity disorder (ADHD). Although this diagnosis has not been associated with an increased risk for substance use disorder, stimulant prescribing has increased, along with misuse and pharmaceutical industry marketing to pediatricians, Hadland and Marshall noted.

"Understanding whether the widespread availability of prescription stimulants is related to rising overdose rates, or if it is simply coincidental, could inform prescribing guidelines," they wrote.

Regardless, pediatricians "should be concerned" about the prevalence of stimulant use among children, particularly in light of the absence of stimulant use disorder treatments, they added.

"[W]hereas widespread distribution of the opioid overdose reversal agent naloxone in the United States has averted innumerable deaths, no comparable antidote exists for stimulants," they wrote. "Preventing stimulant use disorder from developing in the first place remains our best hope for averting downstream harms."

Although the present study did not capture race and ethnicity, racial inequities related to stimulant use should also be of concern, Hadland and Marshall noted. Black and Latinx youth are less likely to receive addiction treatment and more likely to face punitive measures like incarceration for drug-related charges compared with white youth.

Among all young people, substance use treatment is lacking, with about one-third of youth presenting to the ED with suspected overdose being linked to addiction treatment, and even fewer receiving treatment after a heroin overdose, Roehler reported.

Absent from this study are data on polysubstance overdoses, which is needed to determine how many stimulant-related overdoses involved fentanyl, benzodiazepines, and alcohol, the editorialists noted.

The study collected data from all cases in which overdose was the chief complaint coded in the National Syndromic Surveillance Program. The all-drug category included over-the-counter medications, benzodiazepines, opioids (including heroin, synthetic narcotics, and other unspecified narcotics), and stimulants.

Because a patient's chief complaint does not always correlate with a final diagnosis, these overdoses should be considered "suspected," which is a limitation, the authors noted. Overdoses with various drugs are also not mutually exclusive, and multiple visits from the same patient would each be counted separately, they added.

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