Association between parental overdose and substance use disorder and youth overdose and SUD: A large linked commercial claims study.

BACKGROUND

Youth drug overdoses (OD) and substance use disorders (SUD) are major public health concerns, yet the association between parental and offspring OD is poorly understood and has not been examined using linked insurance claims data. We examined parental OD/SUD associations with youth diagnoses and treatment utilization.

METHODS

Using Merative MarketScan (2017-2024), we studied adolescents (12-17) and young adults (18-25) with a first OD or SUD diagnosis linked to parents/guardians (≥6 months enrollment). Participants were classified as Any OD or SUD-only, with OD + SUD as an Any OD subgroup. Exposure was parental OD/SUD history; secondary outcomes were naloxone, medications for opioids use disorder (MOUD), and behavioral health services within 6 months. Logistic regression adjusted for sex and region.

RESULTS

Among 6.5 million youth, Any OD occurred in 0.5% of adolescents and 0.6% of young adults; SUD-only in 0.8% and 2.6%. Parental OD/SUD was associated with higher odds of Any OD and SUD-only in adolescents (adjusted odds ratios [AORs]: 3.6 [95% CI: 3.4 -3.9] and 3.8 [3.5 -3.9]) and young adults (3.7 [3.5 -4.0] and 3.4 [3.3 -3.5]), respectively. AORs for OD + SUD were 4.3 [3.7 -4.9] and 4.1 [3.7 -4.5], respectively. Naloxone and MOUD receipt were descriptively higher among young adults with parental OD/SUD (p < 0.0001); adolescent treatment and behavioral health utilization did not differ meaningfully by parental diagnosis.

CONCLUSIONS

Parental OD/SUD history was consistently associated with elevated odds of youth OD and SUD, with modest increases in medication receipt only among young adults. Youth from affected families may benefit from early identification and tailored interventions.