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J Clin Psychiatry. 2018 May/Jun;79(3). pii: 17m11678. doi: 10.4088/JCP.17m11678.

Risk Factors for Overdose in Treatment-Seeking Youth With Substance Use Disorders.

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Addiction Recovery Management Services (ARMS), Massachusetts General Hospital, 151 Merrimac St, 6th Fl, Boston, MA 02114.
Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
Addiction Recovery Management Service, Center for Addiction Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA.



Overdoses (ODs) are among the leading causes of death in youth with substance use disorders (SUDs). Our aim was to identify the prevalence of OD and characteristics associated with a history of OD in youth presenting for SUD outpatient care.


A systematic retrospective medical record review was conducted of consecutive psychiatric and SUD evaluations for patients aged 16 to 26 years with DSM-IV-TR criteria SUD at entry into an outpatient SUD treatment program for youth between January 2012 and June 2013. Unintentional OD was defined as substance use without intention of self-harm that was associated with a significant impairment in level of consciousness. Intentional OD was defined as ingestion of a substance that was reported as a suicide attempt. T tests, Pearson χ² tests, and Fisher exact tests were performed to evaluate characteristics associated with a history of OD.


We examined the medical records of 200 patients (157 males and 43 females) with a mean ± SD age of 20.2 ± 2.8 years. At intake, 58 patients (29%) had a history of OD, and 62% of those patients had a history of unintentional OD only (n = 36). Youth with ≥ 2 SUDs were 3 times more likely to have a history of OD compared to youth with 1 SUD (all P < .05). Compared to those without a history of OD, those with an OD were more likely to be female and have lifetime histories of alcohol, cocaine, amphetamine, anxiety, depressive, and/or eating disorders (all P < .05).


High rates of OD exist in treatment-seeking youth with SUD. OD was associated with more SUDs and psychiatric comorbidity.

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