Prevalence of Opioid Use Disorder and Other Substance Use among Adolescents and Young Adults in Medicaid/CHIP, 2015–2019

Figures & data

Figure 1. Past year prevalence of opioid use disorder and other substance use among Medicaid-enrolled adolescents and young adults, 2015–2019.

Figure 2. Prevalence of opioid use disorder and other substance use among Medicaid-enrollees by demographic characteristics, 2015–2019.

Figure 3. Prevalence of opioid use disorder and other substance use among Medicaid-enrollees by health status and select health conditions, 2015–2019.

Figure 4. Prevalence of opioid use disorder and other substance use among Medicaid-enrollees by select types of substance use and select behaviors, 2015–2019.

Appendix Table 1. Socioeconomic characteristics and risk factors among Medicaid-enrolled adolescents (12–17) by type of substance use, 2015–2019.

	Opioid use disorder (OUD)	Other risky opioid use (no OUD)	Other substance use disorder (and no risky opioid use)	Other substance use (no use disorder or other risky opioid use)	No substance use
	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)
Age group
12–14	0.3 (0.2, 0.5)	1.9 (1.5, 2.3)	1.2 (1.0, 1.5)	12.8 (11.9, 13.8)	83.7 (82.7, 84.7)
15–17	0.8 (0.6, 1.0)***	4.2 (3.7, 4.7)***	5.7 (5.2, 6.3)***	30.7 (29.5, 32.0)***	58.6 (57.4, 59.8)***
Gender
Boys	0.4 (0.3, 0.6)	2.5 (2.2, 2.9)	3.4 (3.1, 3.8)	20.5 (19.5, 21.5)	73.2 (72.0, 74.3)
Girls	0.7 (0.5, 0.9)**	3.5 (3.0, 4.0)***	3.4 (3.0, 3.9)	22.7 (21.6, 23.9)***	69.7 (68.4, 71.0)***
Race/Hispanic ethnicity
White	0.6 (0.5, 0.9)	3.2 (2.8, 3.7)	3.7 (3.2, 4.3)	25.2 (23.9, 26.5)	67.2 (66.0, 68.5)
Black or African American	0.4 (0.3, 0.7)	3.1 (2.6, 3.8)	2.7 (2.2, 3.4)**	18.5 (17.4, 19.7)***	75.2 (73.9, 76.4)***
American Indian/Alaska Native	0.5 (0.1, 1.8)	2.7 (1.7, 4.3)	5.4 (3.6, 8.1)	26.0 (21.4, 31.2)	65.4 (59.8, 70.7)
Native Hawaiian/Other Pacific Islander	0.7 (0.2, 2.8)	S	3.9 (1.7, 8.5)	22.7 (14.9, 32.9)	70.1 (59.4, 78.9)
Asian	0.7 (0.2, 2.1)	2.3 (1.3, 4.1)	2.5 (1.4, 4.5)	12.8 (10.1, 16.1)***	81.6 (78.0, 84.7)***
Identifies as two or more races	0.6 (0.3, 1.2)	3.2 (2.2, 4.7)	4.0 (2.8, 5.5)	25.6 (22.6, 28.9)	66.6 (63.5, 69.7)
Hispanic	0.5 (0.3, 0.7)	2.7 (2.3, 3.3)	3.6 (3.1, 4.1)	20.0 (18.6, 21.5)***	73.2 (71.5, 74.8)***
Metropolitan statistical area
Large	0.5 (0.4, 0.7)	3.0 (2.5, 3.4)	3.6 (3.1, 4.1)	20.5 (19.5, 21.6)	72.4 (71.4, 73.4)
Small	0.7 (0.5, 0.9)	3.0 (2.6, 3.5)	3.1 (2.7, 3.5)	22.1 (21.0, 23.3)**	71.1 (69.9, 72.3)**
Nonmetropolitan	0.3 (0.2, 0.5)**	3.1 (2.6, 3.7)	3.6 (3.0, 4.3)	23.9 (22.3, 25.6)***	69.1 (67.5, 70.6)***
Family income as a % of the federal poverty level
<100	0.6 (0.5, 0.9)	2.8 (2.4, 3.3)	3.1 (2.8, 3.6)	19.4 (18.4, 20.5)	74.0 (72.9, 75.1)
100–200	0.4 (0.3, 0.6)	3.2 (2.7, 3.7)	3.5 (3.0, 4.1)	22.4 (21.1, 23.7)***	70.5 (69.1, 71.9)***
>200	0.5 (0.3, 0.9)	3.2 (2.6, 3.9)	4.0 (3.4, 4.7)**	24.9 (23.5, 26.3)***	67.5 (65.7, 69.2)***
Household composition
Both parents in household	0.5 (0.4, 0.8)	2.8 (2.4, 3.3)	2.9 (2.6, 3.3)	19.9 (18.9, 21.0)	73.7 (72.8, 74.7)
Mother only in household	0.5 (0.3, 0.7)	3.0 (2.6, 3.5)	3.9 (3.4, 4.4)***	22.7 (21.6, 23.9)***	70.0 (68.7, 71.2)***
Father only in household	1.1 (0.6, 2.1)	4.1 (2.8, 5.9)	3.6 (2.4, 5.3)	23.6 (20.4, 27.3)**	67.6 (64.0, 71.0)***
Parental status
Does not have a child in the household and not pregnant	0.5 (0.4, 0.7)	3.0 (2.7, 3.3)	3.4 (3.1, 3.7)	21.5 (20.7, 22.3)	71.6 (70.7, 72.4)
Pregnant with first child	0.2 (0.0, 1.5)	5.8 (3.0, 10.8)	S	37.5 (27.7, 48.4)***	46.1 (35.1, 57.5)***
Has one child in the household	S	2.6 (1.1, 6.1)	4.6 (1.7, 11.9)	S	S
Has more than one children in the household	S	S	S	S	S
Number of religious services attended in past year
0	0.5 (0.4, 0.7)	2.5 (2.2, 2.9)	3.4 (3.0, 3.9)	21.9 (20.8, 23.0)	71.7 (70.5, 72.8)
1–2	0.6 (0.4, 1.0)	4.1 (3.3, 5.0)***	3.9 (3.2, 4.9)	24.2 (22.0, 26.5)	67.1 (64.8, 69.4)***
3+	0.5 (0.4, 0.8)	3.2 (2.7, 3.9)**	3.3 (2.8, 3.9)	20.6 (19.3, 22.0)	72.3 (71.0, 73.6)
Number of church or faith-based activities^a
0	0.4 (0.3, 0.7)	3.1 (2.8, 3.5)	3.9 (3.4, 4.4)	23.2 (22.1, 24.2)	69.4 (68.2, 70.6)
1	0.7 (0.5, 1.0)	2.7 (2.1, 3.5)	3.2 (2.6, 3.8)	21.4 (20.2, 22.8)**	72.0 (70.5, 73.5)***
2	0.7 (0.4, 1.2)	3.8 (3.0, 4.8)	3.5 (2.7, 4.6)	22.2 (20.2, 24.3)	69.7 (67.6, 71.8)
3+	0.4 (0.2, 0.7)	2.6 (2.0, 3.3)	2.7 (2.2, 3.3)***	18.2 (16.8, 19.7)***	76.1 (74.6, 77.5)***
Attended school in the past 12 months
Yes	0.5 (0.4, 0.7)	2.8 (2.5, 3.2)	3.2 (2.9, 3.5)	21.2 (20.4, 22.1)	72.3 (71.4, 73.2)
No	0.7 (0.5, 1.1)	3.8 (3.3, 4.5)***	4.6 (3.7, 5.7)***	23.3 (21.6, 25.1)**	67.5 (65.7, 69.3)***
Number of school-based activities^b
0	0.4 (0.3, 0.6)	2.6 (2.1, 3.2)	3.9 (3.2, 4.7)	21.4 (19.9, 22.9)	71.7 (70.0, 73.3)
1	0.5 (0.3, 0.8)	2.8 (2.3, 3.4)	3.2 (2.7, 3.8)	20.6 (19.3, 21.9)	72.9 (71.5, 74.3)
2+	0.6 (0.5, 0.8)**	3.3 (2.8, 3.8)	3.4 (3.0, 3.8)	22.2 (21.1, 23.4)	70.5 (69.3, 71.7)
Health status
Excellent, very good or good	0.5 (0.4, 0.6)	2.9 (2.6, 3.3)	3.3 (3.0, 3.6)	21.5 (20.6, 22.3)	71.9 (71.0, 72.7)
Fair or poor	1.5 (0.9, 2.4)***	3.9 (2.6, 5.8)	6.3 (4.9, 8.0)***	23.2 (20.4, 26.3)	65.2 (61.1, 69.1)***
Number of chronic conditions^c
0	0.4 (0.3, 0.6)	2.8 (2.5, 3.1)	3.4 (3.1, 3.7)	21.4 (20.5, 22.3)	72.0 (71.0, 73.0)
1	0.7 (0.5, 1.1)**	3.6 (2.8, 4.6)	3.5 (2.9, 4.2)	22.7 (21.4, 24.1)	69.5 (67.9, 71.0)***
2+	1.5 (0.8, 2.7)**	4.3 (3.1, 6.0)**	4.3 (2.9, 6.1)	20.1 (17.3, 23.3)	69.8 (66.6, 72.9)
Cigarette dependence in past month
No	0.5 (0.4, 0.6)	2.8 (2.5, 3.1)	3.1 (2.8, 3.4)	21.0 (20.2, 21.9)	72.6 (71.7, 73.4)
Yes	4.5 (2.4, 8.4)***	15.0 (11.3, 19.6)***	25.6 (20.7, 31.3)***	54.9 (48.6, 60.9)***	S
Sexually transmitted disease, past year
No	0.5 (0.4, 0.6)	2.9 (2.6, 3.2)	3.3 (3.0, 3.6)	21.4 (20.5, 22.2)	72.0 (71.1, 72.8)
Yes	3.3 (1.4, 7.2)**	9.8 (5.7, 16.2)**	16.1 (12.1, 21.1)***	33.2 (27.7, 39.1)***	37.8 (30.8, 45.3)***
Depressive episode in the last year
No	0.4 (0.3, 0.5)	2.5 (2.3, 2.8)	2.8 (2.5, 3.1)	19.9 (19.1, 20.8)	74.4 (73.5, 75.3)
Yes	1.7 (1.2, 2.5)***	6.0 (4.8, 7.5)***	7.6 (6.5, 8.9)***	32.5 (30.5, 34.5)***	52.1 (50.3, 54.0)***
Driven after substance use, past year^d
No	0.4 (0.3, 0.5)	2.3 (2.0, 2.7)	2.7 (2.4, 3.0)	20.9 (20.0, 21.9)	73.7 (72.7, 74.6)
Yes	8.0 (4.9, 12.8)***	21.4 (17.1, 26.4)***	35.7 (29.9, 41.9)***	35.0 (28.6, 41.9)***	S
Heavy alcohol use, past month^e
No	0.5 (0.4, 0.6)	2.9 (2.6, 3.3)	3.3 (3.0, 3.6)	21.5 (20.7, 22.3)	71.9 (71.0, 72.7)
Yes	10.7 (5.5, 19.7)***	17.3 (10.8, 26.5)***	35.5 (25.6, 46.8)***	36.6 (26.6, 47.8)***	S

Source: All estimates are from SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015–2019.

Notes: Substance use disorder is defined as meeting criteria for dependence or abuse according to the Diagnostic and Statistical Manual of Mental Disorder, 4th edition (DSM-IV) based on self-reported substance use and consequences from any of the following substances: alcohol, marijuana, cocaine, hallucinogens, inhalants, methamphetamine, ecstasy, lysergic acid diethylamide (LSD), Phenylcyclohexyl piperidine (PCP), or non-medical use of sedatives, stimulants, or tranquilizers. “Other risky opioid use" includes individuals the NSDUH identifies as "misusing" opioids because they report using opioids in a way not directed by a doctor. Other substances use is defined as use of the aforementioned substances as well as the use of tobacco.

Adolescents include people ages 12–17 and young adults include people ages 18–25.

Note. ***/** indicates that the estimate differs significantly from the first level of each row variable, within each substance use column (e.g., the estimate for girl respondents with opioid use disorder differs significantly from the estimate for boy respondents with opioid use disorder) at the .01/.05 level, respectively, using a two-tailed test of significance.

"S" Data were suppressed using NSDUH's suppression criteria for unreliable estimates.

^aChurch or faith-based activities include clubs, youth groups, Saturday or Sunday school, prayer groups, youth trips, service or volunteer activities. NSDUH only asks this question of youth ages 12–17.

^bSchool-based activities include team-based sports, cheerleading, choir, band, student government, and other clubs. NSDUH only asks this question of youth ages 12–17.

^cChronic conditions include high blood pressure, heart conditions, diabetes, cancer, asthma, COPD, HIV/AIDS, Hepatitis B, Hepatitis C, cirrhosis, and kidney disease.

^dThis variable corresponds to a question that asks respondents if they have driven under the influence of the following substances: marijuana, cocaine or crack, heroin, hallucinogens, inhalants, and methamphetamine.

^eHeavy alcohol use is computed using NSDUH definitions which were developed for adults and is defined as drinking five or more drinks on the same occasion for boys or four or more drinks on the same occasion for girls on each of 5 or more days in the past 30 days. For this variable, "occasion" means at the same time or within a couple hours of each other.

Appendix Table 2. Socioeconomic characteristics and risk factors among Medicaid-enrolled young adults (18–25) by type of substance use, 2015–2019.

	Opioid use disorder (OUD)	Other risky opioid use (no OUD)	Other substance use disorder (and no risky opioid use)	Other substance use (no use disorder or other risky opioid use)	Nonter substance use
	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)
Age group
18–20	1.1 (0.9, 1.4)	5.0 (4.5, 5.6)	7.7 (6.9, 8.6)	47.3 (45.8, 48.8)	38.9 (37.3, 40.5)
21–23	1.7 (1.4, 2.2)**	6.9 (6.0, 7.8)***	9.9 (9.0, 11.0)***	61.3 (59.7, 62.9)***	20.1 (18.9, 21.5)***
24–25	2.4 (1.8, 3.1)***	6.2 (5.3, 7.2)**	8.5 (7.6, 9.5)	62.8 (61.2, 64.3)***	20.2 (18.7, 21.7)***
Gender
Men	1.9 (1.6, 2.3)	5.8 (5.0, 6.8)	10.7 (9.8, 11.6)	51.5 (50.0, 53.0)	30.1 (28.7, 31.5)
Women	1.4 (1.2, 1.6)**	5.8 (5.4, 6.4)	7.2 (6.6, 7.8)***	57.4 (56.1, 58.7)***	28.2 (27.3, 29.1)**
Race/Hispanic ethnicity
White	2.8 (2.3, 3.3)	7.0 (6.3, 7.8)	8.4 (7.4, 9.6)	60.0 (58.2, 61.8)	21.9 (20.4, 23.4)
Black or African American	0.7 (0.4, 1.1)***	5.0 (4.3, 5.9)***	9.3 (8.0, 10.8)	52.0 (49.7, 54.3)***	32.9 (31.2, 34.7)***
American Indian/Alaska Native	1.7 (0.6, 4.8)	7.1 (4.0, 12.3)	20.3 (13.0, 30.5)***	48.9 (40.5, 57.3)**	22.0 (17.4, 27.5)
Native Hawaiian/Other Pacific Islander	S	S	8.1 (4.0, 15.5)	S	S
Asian	0.9 (0.3, 2.7)***	4.3 (2.5, 7.1)**	4.5 (3.0, 6.7)***	44.8 (40.9, 48.9)***	45.5 (41.1, 50.0)***
Identifies as two or more races	1.8 (0.9, 3.5)	7.3 (4.8, 10.8)	8.9 (6.8, 11.6)	61.9 (57.6, 66.0)	20.1 (16.5, 24.4)
Hispanic	1.0 (0.6, 1.4)***	5.1 (4.3, 6.0)***	8.4 (7.5, 9.3)	52.9 (50.9, 55.0)***	32.6 (31.0, 34.3)***
Metropolitan statistical area
Large	1.4 (1.1, 1.9)	5.0 (4.4, 5.7)	9.0 (8.4, 9.8)	53.9 (52.7, 55.0)	30.6 (29.5, 31.8)
Small	1.7 (1.3, 2.1)	6.5 (5.7, 7.4)***	8.3 (7.4, 9.3)	55.4 (53.6, 57.2)	28.1 (26.5, 29.7)**
Nonmetropolitan	1.9 (1.3, 2.7)	7.4 (6.1, 9.0)***	7.4 (6.2, 8.9)**	58.8 (56.5, 61.1)***	24.4 (22.5, 26.5)***
Family income as a % of the federal poverty level
<100	1.4 (1.1, 1.8)	6.3 (5.5, 7.1)	7.7 (7.0, 8.6)	53.6 (52.3, 55.0)	31.0 (29.9, 32.1)
100–200	1.9 (1.5, 2.4)	5.3 (4.5, 6.1)	8.1 (7.1, 9.1)	56.4 (54.3, 58.5)**	28.4 (26.5, 30.3)**
>200	1.6 (1.2, 2.2)	5.9 (4.9, 7.0)	10.5 (9.4, 11.7)***	56.0 (53.9, 58.1)	26.0 (24.4, 27.8)***
Parental status
Does not have a child in the household and not pregnant	1.6 (1.3, 1.8)	5.7 (5.2, 6.2)	9.3 (8.7, 9.9)	52.4 (51.4, 53.5)	31.1 (30.0, 32.2)
Pregnant with first child	1.3 (0.6, 3.0)	7.2 (3.9, 12.9)	9.1 (6.2, 13.2)	50.7 (45.2, 56.1)	31.7 (26.2, 37.8)
Has one child in the household	1.9 (1.3, 2.8)	5.5 (4.5, 6.7)	7.5 (6.2, 9.0)**	61.1 (58.5, 63.6)***	24.0 (21.6, 26.6)***
Has more than one children in the household	1.3 (0.9, 1.9)	6.7 (5.5, 8.0)	5.8 (4.7, 7.0)***	64.0 (61.7, 66.2)***	22.2 (20.1, 24.6)***
Number of religious services attended in past year
0	1.8 (1.5, 2.1)	6.2 (5.5, 7.0)	9.0 (8.2, 9.8)	55.2 (54.0, 56.4)	27.9 (26.8, 29.0)
1–2	1.8 (1.2, 2.7)	5.5 (4.4, 6.9)	10.1 (8.7, 11.7)	58.1 (55.6, 60.5)**	24.5 (22.2, 27.0)**
3+	1.2 (0.8, 1.8)	5.4 (4.7, 6.2)	7.5 (6.6, 8.5)**	54.0 (52.4, 55.6)	32.0 (30.2, 33.8)***
Attended school in the past 12 months
Yes	0.9 (0.7, 1.2)	4.4 (3.9, 5.0)	8.2 (7.5, 9.1)	52.2 (50.8, 53.6)	34.3 (32.7, 35.8)
No	2.0 (1.7, 2.4)***	6.8 (6.2, 7.4)***	8.9 (8.2, 9.6)	57.2 (56.1, 58.3)***	25.1 (24.0, 26.3)***
Health status
Excellent, very good or good	1.4 (1.2, 1.6)	5.5 (5.0, 5.9)	8.3 (7.8, 8.8)	55.1 (54.1, 56.0)	29.7 (28.9, 30.6)
Fair or poor	3.0 (2.2, 4.2)***	9.2 (7.6, 11.0)***	10.8 (9.0, 13.0)**	54.8 (51.3, 58.2)	22.2 (19.5, 25.1)***
Number of chronic conditions^a
0	1.3 (1.1, 1.6)	5.4 (4.9, 5.9)	8.6 (8.1, 9.1)	55.1 (54.2, 56.0)	29.6 (28.8, 30.4)
1	2.4 (1.8, 3.1)***	6.7 (5.7, 8.0)**	8.7 (7.5, 10.1)	55.2 (52.8, 57.5)	27.0 (24.8, 29.3)**
2+	3.1 (2.0, 4.7)**	9.8 (6.9, 13.9)**	8.0 (5.3, 11.9)	53.4 (48.4, 58.4)	25.7 (22.4, 29.3)**
Cigarette dependence in past month
No	0.7 (0.5, 0.9)	4.9 (4.4, 5.3)	7.4 (7.0, 7.8)	53.7 (52.8, 54.6)	33.4 (32.5, 34.2)
Yes	7.3 (6.1, 8.7)***	12.3 (10.5, 14.3)***	16.4 (14.7, 18.3)***	64.0 (61.6, 66.3)***	S
Sexually transmitted disease, past year
No	1.5 (1.2, 1.7)	5.5 (5.0, 5.9)	8.1 (7.7, 8.6)	55.3 (54.5, 56.1)	29.7 (28.9, 30.5)
Yes	4.5 (2.9, 6.9)***	11.9 (9.6, 14.7)***	18.1 (14.6, 22.2)***	52.4 (47.6, 57.3)	13.1 (10.0, 16.9)***
Depressive episode in the last year
No	1.2 (1.0, 1.4)	5.4 (4.8, 5.9)	7.5 (7.0, 8.1)	55.3 (54.4, 56.2)	30.6 (29.7, 31.4)
Yes	4.2 (3.3, 5.3)***	9.5 (8.0, 11.1)***	16.4 (14.4, 18.7)***	52.9 (50.6, 55.3)	16.9 (14.7, 19.5)***
Sexual identity
Heterosexual	1.5 (1.3, 1.7)	5.2 (4.7, 5.8)	8.3 (7.9, 8.8)	54.9 (54.0, 55.8)	30.1 (29.2, 31.0)
Lesbian or gay	0.8 (0.3, 1.9)	9.8 (6.4, 14.7)**	10.4 (7.5, 14.4)	62.1 (56.1, 67.8)**	16.8 (12.8, 21.8)***
Bisexual	2.8 (1.9, 3.9)**	9.5 (7.9, 11.5)***	11.0 (9.2, 13.2)**	60.5 (56.8, 64.1)***	16.2 (13.8, 18.9)***
Driven after substance use, past year^b
No	0.9 (0.7, 1.2)	4.3 (3.8, 4.7)	6.5 (6.0, 6.9)	55.7 (54.5, 56.8)	32.7 (31.8, 33.6)
Yes	6.6 (5.1, 8.4)***	17.9 (15.1, 21.0)***	31.1 (28.0, 34.3)***	44.5 (41.4, 47.6)***	S
Heavy alcohol use, past month^c
No	1.4 (1.2, 1.6)	5.3 (4.9, 5.8)	7.4 (7.0, 7.8)	55.4 (54.6, 56.3)	30.5 (29.7, 31.3)
Yes	5.1 (3.8, 6.9)***	15.3 (12.5, 18.6)***	31.7 (27.8, 35.9)***	47.9 (43.2, 52.6)***	S

Source: All estimates are from SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015–2019.

Notes: Substance use disorder is defined as meeting criteria for dependence or abuse according to the Diagnostic and Statistical Manual of Mental Disorder, 4th edition (DSM-IV) based on self-reported substance use and consequences from any of the following substances: alcohol, marijuana, cocaine, hallucinogens, inhalants, methamphetamine, ecstasy, lysergic acid diethylamide (LSD), Phenylcyclohexyl piperidine (PCP), or non-medical use of sedatives, stimulants, or tranquilizers. “Other risky opioid use" includes individuals the NSDUH identifies as "misusing" opioids because they report using opioids in a way not directed by a doctor. Other substances use is defined as use of the aforementioned substances as well as the use of tobacco.

Adolescents include people ages 12–17 and young adults include people ages 18–25.

Note. ***/** indicates that the estimate differs significantly from the first level of each row variable, within each substance use column (e.g., the estimate for girl respondents with opioid use disorder differs significantly from the estimate for boy respondents with opioid use disorder) at the .01/.05 level, respectively, using a two-tailed test of significance.

"S" Data was suppressed using NSDUH's suppression criteria for unreliable estimates.

^aChronic conditions include high blood pressure, heart conditions, diabetes, cancer, asthma, COPD, HIV/AIDS, Hepatitis B, Hepatitis C, cirrhosis, and kidney disease.

^bThis variable corresponds to a question that asks respondents if they have driven under the influence of the following substances: marijuana, cocaine or crack, heroin, hallucinogens, inhalants, and methamphetamine.

^cHeavy alcohol use is computed using NSDUH definitions which were developed for adults and is defined as drinking five or more drinks on the same occasion for boys or four or more drinks on the same occasion for girls on each of 5 or more days in the past 30 days. For this variable, "occasion" means at the same time or within a couple hours of each other.