Mental Health, Quantity of Opioids Linked to Adolescent Overdoses

Preexisting mental health conditions, use of tramadol, and higher number of dispensed tablets were associated with an increased risk for opioid overdose in adolescents.

Although only a small number of adolescents experience opioid overdoses, preexisting mental health conditions, use of tramadol, and a higher number of dispensed tablets increase the risk for overdose, according to results published in Pediatrics.

The study included privately insured adolescents aged 11 to 17 years in the United States who were captured in the Truven MarketScan commercial claims data set from January 2007 to September 2015 (n=1,146,412). The researchers defined opioid overdose as any emergency department visit, inpatient hospitalization, or outpatient healthcare visit during which the participant was diagnosed with opioid overdose.

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Of all participants, 0.06% (n=725) had an opioid overdose, for a rate of 28 events per 100,000 patient-years.

The results indicated that participants who received ≥30 opioid tablets had a 35% increased risk for overdose compared with those who received ≤18 tablets (hazard ratio [HR], 1.35; 95% CI, 1.05-1.73; P =.02).

Participants’ daily prescribed opioid dose was not independently associated with an increased risk for overdose. However, participants with preexisting mental health conditions had an increased risk for overdose, with HRs ranging from 1.65 for anxiety to 3.09 for substance abuse disorders.

Compared with oxycodone, participants exposed to tramadol had a 2.67-fold increased risk for opioid overdose (adjusted HR, 2.67; 95% CI, 1.90-3.75; P <.0001).

The study included several limitations, including its cross-sectional design. The researchers also noted that the MarketScan database lacks clinical details.

“[T]his study contributes to a better understanding of opioid prescribing patterns in adolescents in an effort to guide effective efforts to prevent patient harm,” the researchers wrote.


Groenewald CB, Zhou C, Palermo TM, Van Cleve WC. Associations between opioid prescribing patterns and overdose among privately insured adolescents [published online October 1, 2019]. Pediatrics. doi:10.1542/peds.2018-4070