Rising Stimulant Overdoses Among Young People in the United States - American Academy of Pediatrics
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Rising Stimulant Overdoses Among
Young People in the United States
Scott E. Hadland, MD, MPH, MS,a,b Brandon D.L. Marshall, PhDc
Although commonly described as an waves.5,6 The first wave, beginning in
opioid crisis, the drug overdose the early 2000s, was largely driven by
epidemic in the United States increases in prescription opioid-related
increasingly involves use of substances overdoses, likely fueled by aggressive
other than opioids.1,2 In this issue of industry marketing of opioid products.7
Pediatrics, Roehler et al3 describe Concomitant with a decrease in opioid
a concerning rise in overdoses among prescribing, heroin began to supplant
children, adolescents, and young adults prescription opioids during the second
related to stimulants such as cocaine, wave of the early 2010s. From late a
Department of Pediatrics, Boston Medical Center, Boston,
methamphetamine, and prescription 2013 onwards, highly potent fentanyl Massachusetts; bDivision of General Pediatrics, Department
of Pediatrics, School of Medicine, Boston University, Boston,
drugs (including those commonly flooded drug markets and contributed Massachusetts; and cDepartment of Epidemiology, School of
used to treat attention deficient/ to unprecedented mortality during the Public Health, Brown University, Providence, Rhode Island
hyperactivity disorder). third wave. Now, in the fourth wave of Opinions expressed in these commentaries are
the crisis, clinicians, public health those of the author and not necessarily those of the
Drawing on 2016–2019 surveillance
experts, and policymakers are American Academy of Pediatrics or its Committees.
data from a plurality of US emergency
grappling with rising overdose fatalities DOI: https://doi.org/10.1542/peds.2020-031526
departments across 47 states, the
involving stimulants, particularly
authors found that whereas visits for Accepted for publication Oct 8, 2020
cocaine and methamphetamine.
drug overdoses rose only slightly Address correspondence to Scott E. Hadland, MD,
among children ,15 and remained Pediatricians and other clinicians MPH, MS, Boston Medical Center, 801 Albany St,
unchanged in adolescents and young Room 2055, Boston, MA 02119.
caring for youth should be concerned.
E-mail: scott.hadland@bmc.org
adults 15 to 24, visits for stimulant Approximately 1 in 25 high school
overdoses increased across all ages. PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online,
students has used cocaine, and 1 in 50
1098-4275).
Specifically, over each quarter between has used methamphetamine.8 Racial
April 2016 and September 2019, Copyright © 2021 by the American Academy of
inequities are pernicious; previous
Pediatrics
stimulant overdose visits among young work has revealed that Black and
people aged 0 to 10, 11 to 14, and 15 to FINANCIAL DISCLOSURE: The authors have indicated
Latinx youth are significantly less likely
they have no financial relationships relevant to this
24 years increased by 3%, 4%, and 2%, to receive timely evidence-based article to disclose.
respectively. addiction treatment.9 These inequities
FUNDING: Dr Hadland received grant support from
These findings mirror other recent are critical not only because of the the National Institute on Drug Abuse (K23DA045085,
national drug overdose trends. excess risk for overdose without L40DA042434) and the Thrasher Pediatric Fund Early
Although the overall US overdose recommended care, but also because Career Award. Dr Marshall received grant support
youth of color are significantly more from the National Institute on Drug Abuse (R01-
mortality rate plateaued in 2018 after DA046620).
climbing for 2 decades,4 preliminary likely than white youth to be
incarcerated for drug-related charges POTENTIAL CONFLICT OF INTEREST: The authors have
2019 data suggest a return to indicated they have no potential conflicts of interest
increasing year-over-year rates.1 and to experience lifelong adverse
to disclose.
Nationally, deaths involving cocaine and health consequences stemming from
COMPANION PAPER: A companion to this article can
other stimulants increased sharply criminal justice involvement.
be found online at www.pediatrics.org/cgi/doi/10.
after 2016, including among youth ages 1542/2020-003491.
What should also concern clinicians is
15 to 24.1,5
the exceptional difficulty of treating
The overdose crisis is complex and stimulant use disorder. Whereas opioid To cite: Hadland SE and Marshall BDL. Rising
Stimulant Overdoses Among Young People in the
evolving. Public health experts have use disorder is effectively treated
United States. Pediatrics. 2021;147(1):e2020031526
described it as having occurred in with US Food and Drug
Downloaded from www.aappublications.org/news by guest on January 4, 2021
PEDIATRICS Volume 147, number 1, January 2021:e2020031526 COMMENTARYAdministration–approved Understanding whether the opioid and other drug-related
medications,10 there are no approved widespread availability of overdoses among youth in the US,
pharmacotherapies for stimulant use prescription stimulants is related to 2016–2019. Pediatrics. 2020;147(1):
disorder, and most behavioral rising overdose rates, or if it is simply 2020003491e
therapies are disappointingly coincidental, could inform prescribing 4. Wilson N, Kariisa M, Seth P, Smith H IV,
ineffective.11 Similarly, whereas guidelines. Davis NL. Drug and opioid-involved
widespread distribution of the opioid overdose deaths - United States,
overdose reversal agent naloxone in In the meantime, pediatricians and 2017–2018. MMWR Morb Mortal Wkly
the United States has averted other clinicians can take immediate Rep. 2020;69(11):290–297
innumerable deaths,12 no comparable action. They can routinely screen for
5. Kariisa M, Scholl L, Wilson N, Seth P,
antidote exists for stimulants. substance use using a validated tool Hoots B. Drug overdose deaths
Preventing stimulant use disorder (eg, Screening to Brief Intervention, involving cocaine and psychostimulants
from developing in the first place https://www.drugabuse.gov/ast/ with abuse potential - United States,
remains our best hope for averting s2bi/; Brief Screener for Tobacco, 2003–2017. MMWR Morb Mortal Wkly
downstream harms. Alcohol, and other Drugs, https:// Rep. 2019;68(17):388–395
www.drugabuse.gov/ast/bstad/; Car, 6. Gaither JR, Shabanova V, Leventhal JM. US
Roehler et al draw much-needed Relax, Alone, Forget, Family/Friends, national trends in pediatric deaths from
early attention to this worsening Trouble, https://crafft.org/), counsel prescription and illicit opioids, 1999–2016.
public health problem. Further on substance use, and refer to JAMA Netw Open. 2018;1(8):e186558
studies are needed. The authors addiction treatment when
7. Hadland SE, Cerdá M, Li Y, Krieger MS,
examine overdoses among 15- to 24- needed.20,21 As respected citizens in Marshall BDL. Association of
year-olds collectively; more granular their communities, clinicians can pharmaceutical industry marketing of
age data would shed light on the advocate for evidence-based opioid products to physicians with
precise times that overdoses are prevention programming in schools subsequent opioid prescribing. JAMA
rising during adolescence and young and other settings. When clinicians Intern Med. 2018;178(6):861–863
adulthood. Data are also needed on prescribe stimulants, they can 8. US Centers for Disease Control and
how stimulant overdoses in youth counsel parents that they should Prevention. YRBSS results. 2020.
are related to rising fentanyl ensure safe, locked storage of Available at: https://www.cdc.gov/
overdose6 and to polysubstance use medications, which is especially healthyyouth/data/yrbs/results.htm.
more broadly, including use of critical given the rising rates of Accessed September 11, 2020
benzodiazepines and alcohol.13,14 presumably unintentional stimulant 9. Hadland SE, Wharam JF, Schuster MA,
Finally, researchers should take care overdoses observed in younger ages Zhang F, Samet JH, Larochelle MR. Trends
to identify differences by race and in the study by Roehler et al. Given in receipt of buprenorphine and
ethnicity to ensure that our clinical that preliminary national 2019 data naltrexone for opioid use disorder among
and public health responses reduce suggest that overdose rates have once adolescents and young adults, 2001–2014.
inequities rather than exacerbate again resumed their climb,1 JAMA Pediatr. 2017;171(8):747–755
them.15 addressing stimulant misuse and 10. Committee on Substance Use and
Researchers should also pursue overdose early in the life course is Prevention. Medication-assisted
a greater understanding of which urgent. treatment of adolescents with opioid
use disorders. Pediatrics. 2016;138(3):
stimulants are involved in the
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PEDIATRICS Volume 147, number 1, January 2021 3Rising Stimulant Overdoses Among Young People in the United States
Scott E. Hadland and Brandon D.L. Marshall
Pediatrics 2021;147;
DOI: 10.1542/peds.2020-031526 originally published online December 7, 2020;
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/147/1/e2020031526
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Downloaded from www.aappublications.org/news by guest on January 4, 2021Rising Stimulant Overdoses Among Young People in the United States
Scott E. Hadland and Brandon D.L. Marshall
Pediatrics 2021;147;
DOI: 10.1542/peds.2020-031526 originally published online December 7, 2020;
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/147/1/e2020031526
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