Opioid overdose experiences in a sample of US adolescents and young adults: a thematic analysis

Abstract

Background and Aims Opioid overdose deaths among adolescents and young adults have risen sharply in the United States over recent decades. This study aimed to explore the nature of adolescent and young adult perspectives on overdose experiences. Design This study involved thematic analysis of interviews undertaken as part of a mixed‐methods, randomized trial of extended release naltrexone (XR‐NTX) versus treatment‐as‐usual (TAU) for adolescents and young adults (aged 15–21 years) with opioid use disorder (OUD). Setting Participants were recruited during a residential treatment episode at Mountain Manor Treatment Center, in Baltimore, MD, USA. Participants/cases As part of the qualitative component of this study, 35 adolescents/young adults completed up to three interviews: at baseline, 3 and 6 months after release from residential opioid use disorder treatment. Measurements Semi‐structured interviews solicited participant experiences with opioid use disorder treatment; their satisfaction with the medications used to treat opioid use disorder; counseling received; current substance use; issues related to treatment retention; their treatment goals; and their future outlook. Findings Four broad themes emerged: (1) adolescents/young adults had difficulty identifying overdoses due to interpreting subjective symptoms and a lack of memory of the event, (2) this sample had difficulty perceiving risk that is misaligned with traditional understandings of overdose intentionality, (3) adolescents/young adults did not interpret personal overdose events as a catalyst for behavior change and (4) this sample experienced a greater impact to behavior change through witnessing an overdose of someone in their social network. Conclusions The sample of US adolescents and young adults in treatment for opioid use disorder expressed difficulty identifying whether or not they had experienced an overdose, expressed fluctuating intentionality for those events and did not have clear intentions to change their behavior. Witnessing an overdose appeared to be as salient an experience as going through an overdose oneself.

Years of Life Lost to Unintentional Drug Overdose Rapidly Rising in the Adolescent Population, 2016–2020

“…The 113% increase in YLL to unintentional overdose is contrasted to the change in YLL to intentional overdose, which remained stable from 2019 to 2020. However, it can often be difficult to distinguish whether an overdose is intentional or unintentional [30]. Adolescent-aged participants in a 2020 study detailed their experiences with opioid-related overdose and described the desire to reach a state of maximum high without the intention of overdosing to the point of dying [30].…”

“…However, it can often be difficult to distinguish whether an overdose is intentional or unintentional [30]. Adolescent-aged participants in a 2020 study detailed their experiences with opioid-related overdose and described the desire to reach a state of maximum high without the intention of overdosing to the point of dying [30]. Therefore, although the data collected show a significant contrast between YLL to unintentional and intentional overdoses, the difference between the two might be smaller than what is shown due to the reality that intentionality of an overdose is more of a spectrum than a binary construct [30].…”

Examination of Correlates of OUD Outcomes in Young Adults: Secondary Analysis From the XBOT Trial

“…Future research should explore these notable characteristics and other candidates in larger samples of young adults, and should utilize assessments and measurements specifically designed to address hypotheses related to developmental vulnerability. Such variables could include measures of impulsiveness, emotion regulation, excitement-seeking, 24 perceptions of harm, 28 further exploration of sources of motivation, 19 therapeutic alliance and treatment engagement, 7,8,10 perceptions and use of social supports, 11,12 deviant peer affiliations, psychiatric comorbidity, 25 and parental and other caregiver status. An area of particular interest would be a more detailed exploration of cognitive differences in relation to treatment outcomes, especially in executive function, [29][30][31][32] since the developmental literature clearly points to immaturity in youth, some studies have found deficits in youth SUD populations, [33][34][35] and some have shown associations with poorer treatment outcomes.…”

Improving Treatment Together: a protocol for a multi-phase, community-based participatory, and co-design project to improve youth opioid treatment service experiences in British Columbia

“…This is a critical developmental period, and an age period when substance use initiation is at its peak [ 13 – 16 ]. Research into perceptions of substance use suggest that youth view it as acceptable and with low risks; and thus, youth may be less likely to recognize the harms associated with substance use and when support may be needed [ 15 , 17 – 19 ]. It is also widely known that earlier initiation of opioid use increases the risk of developing OUD and other longer-term health and social harms (e.g.…”