In what experts have termed the fourth wave of the ongoing US overdose crisis, nonfatal stimulant overdoses continue to rise. The increase of such overdoses in young people is particularly concerning.

Between April 2016 and September 2019, nonfatal stimulant overdoses increased by 2.3% among those 15- to 24-years-old, 4% among those 11-to 14-years-old, and 3.3% among those under 10-years-old, according to data from the CDC’s National Syndromic Surveillance Program.1 Addressing stimulant misuse (nonmedical use of prescribed medication) and/or illicit use (abuse) early in someone’s life is crucial, as 2019 data suggest that fatal overdose rates have again started climbing.2

The stimulants tracked include cocaine, methamphetamine, and prescription drugs (including those commonly used to treat ADHD). According to public health experts, the overdose crisis began in the early 2000s with nationwide increases in prescription opioid-related overdoses, followed by a second wave including heroin as a replacement to prescription opioids, and a third wave including fentanyl.3

National self-report surveys report that most youth will participate in some form of substance use before they graduate from high school. Approximately 1 in 25 high school students has used cocaine, and 1 in 50 students has used methamphetamine.4 The 2018 National Survey on Drug Use and Health showed that individuals aged 18 to 25 years had the highest part-year prevalence of illicit drug use.5

Psychostimulants, Adolescents, and Overdoses

Another recent study showed that psychostimulants, such as amphetamine and MDMA (ie, ecstasy/molly), were the cause of an increasing number of visits to the emergency department (ED) for those between 0 and 24 years of age.6 Researchers found that nonfatal ED visits for psychostimulant overdoses between 2015 and 2016 increased by 10.1% for those under age 14, 9.4% for 15- to 19-year-olds, and 9.9% for 19- to 24-year-olds.6

Although the focus of the drug overdose epidemic over the past several years has been on adults, it is important to investigate the effects on youth, according to Douglas R. Roehler, PhD, MPH, an epidemiologist at the CDC’s Division of Overdose Prevention, National Center for Injury Prevention and Control, in Atlanta.1 Nonmedical use of drugs during childhood and adolescence can have lasting consequences. Children exposed to substance use at home are at increased risk for poorer outcomes as an adult, as compared with children without such exposure. Such adverse childhood experiences (ACEs) may also increase the likelihood for misuse of prescription drugs by older youth.7

Studies have shown that using drugs during youth can increase the risk for delinquency, academic underachievement, drug use disorder, teenage pregnancy, and depression. Developing brains are particularly vulnerable to the acute effects of drug use, which may predispose youth to develop a substance use disorder as an adult. Recent data from the Youth Risk Behavior Survey demonstrate that lifetime illicit drug use, such as with cocaine and methamphetamines, among 9th to 12th graders has decreased from 2009 to 2019. However, 11th and 12th graders had significantly higher rates than their younger peers, suggesting the onset of developmental effects.8

In the CDC study, there were 89,536,857 ED visits for those between 0 and 24 years between April 2016 and September 2019. Suspected stimulant overdoses increased in each of the three age groups, with those aged 11 to 14 years experiencing the largest increase. Among children under age 10, there were 0.6 suspected stimulant overdoses per 10,000 ED visits. Among those aged 11 to 14 years, there were 0.7 suspected stimulant overdoses. And in adolescents 15- to 24-years-old, there were 2.65 suspected stimulant overdoses.1

These findings also may reflect trends in fatality data, with stimulant deaths representing a growing proportion of drug overdose deaths in the US, specifically related to cocaine and psychostimulants.1,6

Stimulant Use Disorder is a Rising Concern

In their recent paper, Hadland and Marshall expressed concern over these statistics for several reasons. One, with widespread racial inequities, they say that youth of color are significantly less likely to receive timely, evidence-based addiction treatment, which increases their risk for overdose. In addition, Black and Latinx youth are more likely to be incarcerated for drug-related charges and experience lifelong adverse health consequences resulting from criminal justice involvement.3

Also of concern is the extreme difficulty of treating stimulant use disorder. Unlike the availability of medications to treat opioid use disorder (OUD) and alcohol use disorder (AUD), there are no approved pharmacotherapies for stimulant use disorder. In addition, unlike naloxone for opioids, there is also no antidote for stimulant overdose, leaving prevention as our best hope for averting downstream harms.2

Clinicians Can Help Identify and Prevent Future Misuse of Stimulants

The most effective treatments for addiction to methamphetamines are multifaceted behavioral therapies that include individual counseling, family education, 12-step programs, and extracurricular activities.1 More immediately, pediatricians and other clinicians can routinely screen for substance use using a validated tool, counsel on substance use, and refer to addiction treatment when indicated.

Commonly used online screening tools for substance misuse in youth:

Mental health professionals can also advocate for prevention programming in schools and other settings. When they prescribe stimulants, they can counsel parents on ensuring safe, locked storage of medications, particularly in light of the rising number of unintentional stimulant overdoses observed in younger ages.

Looking ahead, Hadland and Marshall wrote that additional research is needed to identify more precise times during adolescence and young adulthood that overdoses are rising.3 More data are needed on how stimulant overdoses in youth are related to rising fentanyl overdose and to polysubstance use, including the use of benzodiazepines and alcohol. Further, researchers should take care to identify racial and ethnic differences in use so that clinical and public health responses reduce inequities rather than exacerbate them.3 Research teams should also try to understand which stimulants are involved in the pathway to misuse, addiction, and overdose – for instance, cocaine and methamphetamine, prescription pills, or both.

Related Articles

ADHD stimulant prescribing concerns, and more on the links between adverse childhood events and ADHD

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Last Updated: May 7, 2021