Trends, disparities, and the impact of COVID-19 on drug overdose mortality among adolescents and young adults in the United States.

BACKGROUND

Drug overdose remains a critical public health concern in the United States (U.S.); however, comprehensive assessments of related mortality patterns among U.S. adolescents and young adults aged 10-24 years are limited.

METHODS

This study analyzed mortality data from 1999 to 2024 using the CDC WONDER database. Mortality rates were stratified by demographic and regional variables, and temporal trends were evaluated using joinpoint regression analysis. Excess mortality during the COVID-19 pandemic and percentage point changes across the prepandemic (2018-2019), pandemic (2020-2022), and postpandemic (2023-2024) periods were calculated.

RESULTS

Between 1999 and 2024, 103,779 drug overdose deaths were recorded among adolescents and young adults. Before the pandemic (1999-2019), the overall mortality rate increased from 2.14 to 7.60 per 100,000 persons and was consistently higher among males, young adults aged 20-24 years, non-Hispanic white individuals, and residents of the Northeast, with increasing trends across all the subgroups. During the pandemic, observed mortality exceeded expected levels by 35.3%, 34.1%, and 17.3% in 2020, 2021, and 2022, respectively. During the postpandemic period, overall mortality returned to prepandemic levels but remained elevated among females (+12.5%), adolescents aged 10-19 years (+63.3%), all non-White racial groups, particularly non-Hispanic Black individuals (+91.0%), and residents of the South (+26.5%) and West (+16.2%).

CONCLUSIONS

Marked disparities in drug overdose mortality persist among U.S. adolescents and young adults. The COVID-19 pandemic resulted in substantial excess mortality and exacerbated preexisting inequities, underscoring the urgent need for targeted interventions and sustained prevention in this vulnerable population.