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Abstract
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Although commonly described as an opioid crisis, the drug overdose epidemic in the United States increasingly involves use of substances other than opioids.1,2 In this issue of Pediatrics, Roehler et al3 describe a concerning rise in overdoses among children, adolescents, and young adults related to stimulants such as cocaine, methamphetamine, and prescription drugs (including those commonly used to treat attention deficient/hyperactivity disorder).
Drawing on 2016-2019 surveillance data from a plurality of US emergency departments across 47 states, the authors found that whereas visits for drug overdoses rose only slightly among children <15 and remained unchanged in adolescents and young adults 15 to 24, visits for stimulant overdoses increased across all ages. Specifically, over each quarter between April 2016 and September 2019, stimulant overdose visits among young people aged 0 to 10, 11 to 14, and 15 to 24 years increased by 3%, 4%, and 2%, respectively.
These findings mirror other recent national drug overdose trends. Although the overall US overdose mortality rate plateaued in 2018 after climbing for 2 decades,4 preliminary 2019 data suggest a return to increasing year-over-year rates.1 Nationally, deaths involving cocaine and other stimulants increased sharply after 2016, including among youth ages 15 to 24.1,5
The overdose crisis is complex and evolving. Public health experts have described it as having occurred in waves.5,6 The first wave, beginning in the early 2000s, was largely driven by increases in prescription opioid-related overdoses, likely fueled by aggressive industry marketing of opioid products.7 Concomitant with a decrease in opioid prescribing, heroin began to supplant prescription opioids during the second wave of the early 2010s. From late 2013 onwards, highly potent fentanyl flooded drug markets and contributed to unprecedented mortality during the third wave. Now, in the fourth wave of the crisis, clinicians, public health experts, and policymakers are grappling with rising overdose fatalities involving stimulants, particularly cocaine and methamphetamine.
Pediatricians and other clinicians caring for youth should be concerned. Approximately 1 in 25 high school students has used cocaine, and 1 in 50 has used methamphetamine.8 Racial inequities are pernicious; previous work has revealed that Black and Latinx youth are significantly less likely to receive timely evidence-based addiction treatment...
Language: en |