Trends of intentional drug overdose among youth: a population-based cohort study

Abstract

Background: Intentional overdose is the commonest form of self-harm in adolescents globally. We explored temporal trends in intentional overdose among youth.

Methods: Using multiple linked healthcare databases, we conducted a population-based cohort study in Ontario, Canada, from 2002 to 2015. We included all patients aged 8 to 19 years who presented to an emergency department (ED) or were hospitalized for intentional overdose, stratifying by age and agent(s) consumed. We determined the annual rate of intentional overdose over time. For context, we contrasted these data against the annual rate of select unintentional injuries (laceration of face or scalp, upper extremity fracture, and accidental burn) in the same group over the same period.

Results: We identified 31,419 unique intentional overdose events in youth, with a striking U-shaped trend apparent over the study period. From 2002 to 2010, hospital presentations for intentional overdose gradually declined. However, from 2010 to 2015, ED visits increased by 75% and hospital admissions doubled. The sharpest increases were observed in adolescents aged 14 to 17 years, and the most commonly implicated substances were acetaminophen, antidepressants and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Over the study period, intentional overdoses involving antidepressants nearly doubled and those involving acetaminophen increased by 50%. In contrast, we observed steady and sustained declines in rates of hospital care for unintentional injuries in the same population over the same period.

Conclusions: Since 2010, intentional overdoses have increased among youth, while other forms of unintentional injury have continued to decline. Further research is needed to understand the reasons for the unexpected rise in intentional overdose in adolescents, and strategies developed to mitigate this phenomenon.

Keywords:

• Adolescents
• overdose
• intentional

Acknowledgements

The authors thank Brogan Inc., Ottawa for use of their Drug Product and Therapeutic Class Database. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information. However, the analyses, conclusions, opinions and statements expressed herein are those of the author, and not necessarily those of the Canadian Institute for Health Information.

Disclosure statement

No potential conflict of interest was reported by the authors.

Availability of data and materials

The dataset from this study is held securely in coded form at ICES. While data sharing agreements prohibit ICES from making the dataset publicly available, access may be granted to whose who meet pre-specified criteria for confidential access, available at www.ices.on.ca/DAS. The full dataset creation plan and underlying analytic code are available from the authors upon request, understanding that the programs may rely upon coding templates or macros that are unique to ICES.

Additional information

Funding

This project was supported by research funds from SickKids Foundation, LCBO (Liquor Control Board of Ontario), The Canadian Drug Safety and Effectiveness Research Network and by ICES, which is funded by a grant from the Ontario Ministry of Health and Long-term Care. The Canadian Drug Safety and Effectiveness Research Network is funded by an Emerging Team Grant from the Canadian Institutes of Health Research (grant no. ETG-9227). The sponsors had no role in the design and conduct of the study; in the collection, analysis and interpretation of the data; or in the preparation, review of approval of the manuscript. The options, results and conclusions reported in the paper are those of the authors and are independent from the funding sources. No endorsement from ICES or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred.