The tables turn after age 17, and experts suggest difference in comorbid mental illness/substance use

Girls age 11-16 years old experience a significantly greater incidence of nonfatal opioid overdoses than their male counterparts, researchers have found. But after age 17, that relationship changes, with the incidence rate becoming greater for males than females.

“Significant differences were found with regard to comorbid psychiatric illness and substance use disorders between males and females,” Sarah M. Bagley, MD, MSc, Grayken Center for Addiction, Department of Medicine, Boston Medical Center, and colleagues wrote and also noted that these differences suggest that there is a need for tailored approaches to address the problem of overdose in these populations.

The study was published in JAMA Network Open.

As pointed out by Bagley and her colleagues, the prevalence of opioid use disorder (OUD) has increased among adolescents, with the rate of diagnosis among youths increasing 6-fold between 2001 and 2015. Meanwhile, the number of opioid-related overdose deaths increased 4-fold between 1999 and 2018.

Yet, questions remain about the specific characteristics of kids and teens who experience opioid overdose, particularly since the risk of opioid overdose risk is different among adult women and men, and some data suggest there is a higher overdose risk among young girls than boys.

Therefore, in this study the authors’ objective was to compare the characteristics of female and male youths who experienced nonfatal opioid overdose, as well as the incidence of nonfatal opioid dose in female and male youths.

This retrospective cohort study used data obtained from the IBM MarketScan Commercial Database from Jan. 1, 2006, through Dec. 31, 2017 on males and females, ages 11 to 24, who had a diagnosis of nonfatal opioid overdose.

Of the 20,312 individuals who had a history of nonfatal opioid overdose, the median age was 20 years, and 56.7% were male. More than half of these individuals (57.8%) had mood and anxiety disorders, while 12.8% had trauma- or stress-related disorders, and 11.7% had attention-deficit/hyperactivity disorder. In addition, at the time of the nonfatal overdose, 38% of youths had OUD, 28% had nicotine use disorder, 17.7% had alcohol use disorder, and 15.2% had cannabis use disorder.

When broken down by sex, among individuals who experienced a nonfatal opioid disorder, being female was associated with having:

  • Mood or anxiety disorder (65.5 versus 51.9%)
  • Trauma- and stress-related disorder (16.4% versus 10.1%)
  • History of suicide attempt or self-harm (14.6% versus 9.9%)
  • Chronic pain (62.1% versus 52.2%)

Being male was associated with having:

  • Attention-deficit/ hyperactivity disorder (13.2% versus 9.8%)
  • OUD (44.7% versus 29.2%)
  • Nicotine use disorder (31.0% versus 24.2%)
  • Cannabis use disorder (18.3% versus 11.3%)
  • Stimulant use disorder (10.8% versus 8.1%)
  • Alcohol use disorder (20.3% versus 14.4%)

Most nonfatal opioid overdoses in youths age 11 to 17 years occurred in females (60%), while starting at age 17 the majority of nonfatal opioid overdoses occurred in males. The incidence rate among female youths aged 11 to 16 years compared to their male counterparts was 0.009 versus 0.005 per 100 person-years, but for young adults 17 to 24 years of age, the rate was higher among males than females (0.083 versus 0.48 per 100 person-years).

“Understanding the potential sex-based differences will be critical to appropriate targeting of interventions,” observed Bagley and her colleagues, and they further suggested their findings have implications for follow-care considering that nonfatal overdoses occurred in large numbers in teens with psychiatric and substance use disorders.

The authors noted that since much of the research on reducing opioid overdose focuses on expanding the immediate treatment for overdose, as well as medication for OUD, “further research to test strategies to integrate treatment for co-occurring psychiatric and other substance use disorders for youths is needed.”

In a commentary accompanying the study, R. Kathryn McHugh, PhD, Division of Alcohol, Drugs and Addiction, McLean Hospital, Belmont, Massachusetts, observed that the study had three important implications for the study and treatment of opioid abuse – “the importance of psychiatric comorbidity in opioid overdose, the overlap between suicide and opioid overdose, and the importance of considering sex differences in opioid research.”

Attention to psychiatric disorders and symptoms should be an important prevention strategy for both sexes, in addition to the possible contribution suicidal motivation plays in opioid overdose, McHugh wrotel And the fact that more young girls (ages 11-16) experienced overdose than boys the same age, while more boys and men after the age of 17 experienced a nonfatal overdose underscores “the importance of considering developmental differences by sex.”

“The study by Bagley and colleagues provides an important reminder that failure to consider factors, such as sex and age, in studies of opioid misuse may result in missing important differences with direct implications for prevention and treatment,” McHugh concluded.

  1. More young girls (ages 11-16) experience nonfatal opioid overdose than their male counterparts. However, that relationship is reversed starting at age 17 with more older males experiencing overdose than older females.

  2. Significant differences were found with regard to comorbid psychiatric illness and substance use disorders between males and females suggesting that there is a need for tailored approaches to address the problem of overdose in these populations.

Michael Bassett, Contributing Writer, BreakingMED™

McHugh RK “The importance of studying sex and gender differences in opioid misuse” JAMA Network Open 2020; DOI:10.1001/jamanetworkopen.2020.30676

None of the authors cited in this article disclosed any relevant relationships.

Cat ID: 254

Topic ID: 253,254,254,570,730,138,192,144,925