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. Author manuscript; available in PMC: 2026 Mar 17.
Published in final edited form as: Pediatrics. 2025 Jun 1;155(6):e2024069488. doi: 10.1542/peds.2024-069488

Changes in Synthetic Opioid–Involved Youth Overdose Deaths in the United States: 2018–2022

Megan Miller 1, Katherine Wheeler-Martin 1, Amanda M Bunting 1, Magdalena Cerdá 1, Noa Krawczyk 1
PMCID: PMC12991060  NIHMSID: NIHMS2138214  PMID: 40392279

Abstract

BACKGROUND AND OBJECTIVE:

Youth overdose deaths have remained elevated in recent years as the illicit drug supply has become increasingly contaminated with fentanyl and other synthetics. There is a need to better understand fatal drug combinations and how trends have changed over time and across sociodemographic groups in this age group.

METHODS:

We used the National Vital Statistics System’s multiple cause of death datasets to examine trends in overdose deaths involving combinations of synthetic opioids with benzodiazepine, cocaine, heroin, prescription opioids, and other stimulants among US youth aged 15 to 24 years from 2018 to 2022 across age, sex, race and ethnicity, and region.

RESULTS:

Overdose death counts rose from 4652 to 6723 (10.85 to 15.16 per 100 000) between 2018 and 2022, with a slight decrease between 2021 and 2022. The largest increases were deaths involving synthetic opioids only (1.8 to 4.8 deaths per 100 000). Since 2020, fatal synthetic opioid–only overdose rates were higher than polydrug overdose rates involving synthetic opioids, regardless of race, ethnicity, or sex. In 2022, rates of synthetic-only overdose deaths were 2.49-times higher among male youths compared with female youths and 2.15-times higher among those aged 20 to 24 years compared with those aged 15 to 19 years.

CONCLUSIONS:

Polydrug combinations involving synthetic opioids continue to contribute to fatal youth overdoses, yet deaths attributed to synthetic opioids alone are increasingly predominant. These findings highlight the changing risks of the drug supply and the need for better access to harm-reduction services to prevent deaths among youth.

INTRODUCTION

Recently, there have been important changes in the trends of drug use and overdose deaths among US youth as youth overdoses continue to remain alarmingly high.1–3 Whereas from 1996 to 2010 the proportion of youth using illicit drugs other than marijuana declined,4 from 2010 to 2022 youth drug use rates remained stable and the rate of fatal overdoses drastically increased, with synthetic opioids driving the majority of overdose deaths since 2014.3,5 In the midst of this tragedy of overdose deaths, more than 200 000 years of life are being lost each year from fatal youth overdoses,6,7 and communities, families, and friends are losing thousands of young loved ones prematurely.8

Trends in youth overdose deaths vary substantially by age, sex, and race and ethnicity. Death rates have consistently been more than 2 times higher for older youth (aged 20–24 years) than younger youth (aged 15–19 years), with the gap continuing to widen each year.9 Up until 2017, the highest rates of youth overdoses were observed among male youth and non-Hispanic American Indian or Alaska Native (AI/AN) youth followed by white non-Hispanic youth.1 However, starting in 2018, the rates of non-Hispanic Black and Hispanic youth overdoses began increasing at faster rates than non-Hispanic white youth, and in 2022 the overdose death rate of both groups surpassed the overdose death rate of white non-Hispanic youth.10 AI/AN youth still experienced the highest rates of overdose deaths in 2022.

Over the past 8 years, the US overdose crisis has evolved into one driven by polydrug use involving stimulants and/or synthetic opioids, particularly fentanyl.5,11,12 However, most of the literature has focused on adults with little research on which specific combinations of drugs are driving overdoses among youth, or how drug combinations differ across demographic subgroups, which are both critical to tailoring efforts to prevent overdose deaths. In this study, we aimed to assess both overall polydrug involvement and the combination of drugs that were driving youth overdose rates and how these specific drug combinations differed and evolved across race and ethnicity, sex, age, region, and time from 2018 to 2022.

METHODS

We used the National Center for Health Statistics, National Vital Statistics System, Multiple Cause of Death data sets13 to examine overdose deaths among youth aged 15 to 24 years from 2018 to 2022.14,15 Drug poisoning deaths were identified through the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10)16 underlying cause codes of X40-X44 (drug poisonings, unintentional), X60–64 (drug poisonings, suicide), X85 (drug poisoning, homicide), and Y10-Y14 (drug poisonings, undetermined intent). We then identified fatal overdoses involving synthetic opioids alone as well as mutually exclusive drug combinations involving synthetic opioids with the top 5 most common other drugs involved in fatal overdoses17: benzodiazepines, cocaine, heroin, natural/semisynthetic opioids (aka “prescription opioids”), and psychostimulants other than cocaine (aka “other stimulants”) on the basis of T codes available in the multiple/contributing cause of death fields. Supplemental Table 1 shows the ICD-10 codes used to determine the exact drug combinations involved in overdose deaths.

We calculated the prevalence and rates of overdose per 100 000 US youth for each year using annual US Census Bureau population estimates by race and ethnicity for any overdose, overdoses involving opioids, overdoses involving synthetic opioids, and the most common aforementioned mutually exclusive drug combinations.18–20 Other specific combinations including more than 2 drugs (eg, synthetic opioids, heroin, and cocaine) were evaluated (Supplemental Table 1) but were excluded owing to low counts. Overdose deaths with unknown Hispanic ethnicity were also excluded (<1% of overdose deaths from 2018 to 2022).

We first calculated the percent change in overdose death rates from 2018 to 2022 and the proportion of all opioid deaths involving each drug combination in 2022. We used a simple Poisson regression model to determine if there were significant changes in fatal overdoses over time for each of the drug combination overdoses using a 2-sided significance level of P less than .5.

Next, we calculated the year-to-year percent change in fatal overdoses for each examined drug combination. We then analyzed overdose outcomes across region and sociodemographic characteristics including age group, sex, and race and ethnicity. The multiple cause of death data set included separate measures for decedent race and ethnicity, which we combined into a 5-level categorical variable corresponding with the population estimates data: white non-Hispanic, Black non-Hispanic, AI/AN non-Hispanic, other non-Hispanic, or Hispanic. Our other non-Hispanic group consisted of Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, other or multiple Asian, Hawaiian, Guamanian, Samoan, other or multiple Pacific Islander, and non-Hispanic decedents of all other and multiple race categories. Rate ratios were calculated among the different demographic groups for each drug combination outcome. White non-Hispanic youth, the largest demographic group, were used as the comparison group for all race and ethnicity analyses to provide robust statistical comparisons in the assessment of disparities. A Bonferroni correction to account for multiple comparisons was used to determine a 2-sided significance level of P less than .002.21 Finally, we analyzed how intersecting sociodemographic factors impacted overdose outcomes. All analyses were performed using R (version 4.4.0; R Core Team) and Stata (version 18.0; StataCorp LLC).21,22

RESULTS

Youth Overall Overdose Deaths

From 2018 to 2022, youth overdose deaths rose from 4652 to 6723 (10.85 to 15.16 deaths per 100 000). Fatal overdoses peaked in 2021 and slightly decreased from 2021 to 2022 (Figure 1). The rate of overdose deaths involving any opioid increased from 8.46 to 12.86 deaths per 100 000, and the rate of fatal overdoses involving synthetic opioids specifically rose from 6.17 to 12.25 deaths per 100 000. Changes in overdose rates overall and by specific drug combinations between 2018 and 2022 are presented in Table 1.

FIGURE 1.

FIGURE 1.

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Rates of all fatal overdose, opioid-involved overdose, and synthetic opioid–involved overdose among those aged 15 to 24 years in the United States from 2018 to 2022.

TABLE 1.

Changes in Fatal Overdose Rates for Youth Aged 15 to 24 Years by Most Common Drug Combination From 2018 to 2022

Drug Combination Rate of Overdose per 100 000 US Youth Percent Change From 2018 to 2022 Percentage of All Opioid Deaths in 2022 Annual Change in the Rate of Overdose, IRR (95% CI)
2018 2022
Any overdose 10.85 15.16 40 – 1.11 (1.04–1.18)a
All opioid overdoses 8.46 12.86 52 – 1.13 (1.05–1.22)a
Any synthetic opioid 6.17 12.25 99 95 1.20 (1.09–1.32)a
Synthetic opioid only 1.59 4.26 168 33 1.27 (1.13–1.43)a
Synthetic opioids and benzodiazepines only 0.24 0.33 36 3 1.13 (0.92–1.40)
Synthetic opioids and cocaine only 0.40 0.89 125 7 1.23 (1.18–1.30)a
Synthetic opioids and heroin only 0.49 0.07 −85 1 0.66 (0.57–0.75)a
Synthetic opioids and prescription opioids only 0.16 0.20 22 2 1.05 (1.01–1.09)a
Synthetic opioids and other stimulants only 0.16 0.89 443 7 1.50 (1.33–1.68)a
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Abbreviation: IRR, incidence rate ratio.

a

P is less than .05.

For fatal overdoses involving synthetic opioids alone, death rates increased sharply from 1.59 to 4.26 deaths per 100 000 youth over the 5-year period (167.8%) (Figure 2). The rate of overdose deaths involving synthetic opioids and heroin decreased, on the other hand, by 85.1% from 2018 (0.49 per 100 000) to 2022 (0.07 per 100 000). Fatal overdose rates involving synthetic opioids and other stimulants (incidence rate ratio [IRR], 1.50; 95% CI, 1.33–1.68), synthetic opioids only (IRR, 1.27, 95% CI, 1.13–1.43), and synthetic opioids and cocaine (IRR, 1.23; 95% CI, 1.18–1.30) had the highest annual change in the rate of overdose deaths (Table 1). The highest percent change in fatal overdose rates occurred between 2019 and 2020, with fatal overdose rates involving synthetic opioids and benzodiazepines (146.3%), synthetic opioids and other stimulants (123.8%), and synthetic opioids only (84.8%) having the highest percent increases (Supplemental Table 2).

FIGURE 2.

FIGURE 2.

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Rates of fatal overdose among those aged 15 to 24 years involving synthetic opioids by the most common drug combinations in the United States from 2018 to 2022.

Not only were rates of youth fatal overdoses involving synthetic opioids alone the highest compared with the other examined drug combinations across the 5-year period regardless of region (Supplemental Figure 1), but they also increased throughout the period in all regions except in the Northeast. The next highest rates of overdoses in the Northeast, Midwest, and South involved synthetic opioids and cocaine only, whereas the West involved synthetic opioids and other stimulants (Supplemental Table 3).

Youth Overdose Deaths by Age Group

Rates of fatal overdoses involving synthetic opioids were consistently higher among youth aged 20–24 years than youth aged 15–19 years regardless of the examined drug combination (Figure 3). However, youth aged 15–19 years had faster rising rates of overdoses involving only synthetic opioids over the 5-year period. In 2018, those aged 20–24 years had 5.63 times the rate (95% CI, 4.55–7.03) of fatal overdoses involving synthetic opioids alone compared with those aged 15–19 years, whereas by 2022, the gap decreased, with those aged 20–24 years having only 2.15 times the rate of fatal overdoses involving synthetic opioids alone compared with those aged 15–19 years (95% CI, 1.95–2.38) (Supplemental Table 4).

FIGURE 3.

FIGURE 3.

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Rates of fatal overdose among those aged 15 to 24 years for the most common drug combinations involving synthetic opioids by age group and sex in the United States from 2018 to 2022. Some data points are suppressed because of low counts.

Youth Overdose Deaths by Sex

Male youths had higher rates of fatal overdoses involving synthetic opioids than female youths across all 5 years for each examined drug combination (Figure 3). Male youths had 2.52 times the rate of fatal overdoses involving synthetic opioids alone in 2018 (95% CI, 2.13–3.00) and 2.49 times the rate of fatal overdoses involving synthetic opioids alone in 2022 compared with female youths (95% CI, 2.25–2.76). Both sexes had similar increases in rates over the 5-year period. Pairwise comparisons of relative rates of overdose across all demographic groups and specific drug combinations are presented in Supplemental Table 4.

Youth Overdose Deaths by Race and Ethnicity

Figure 4 presents rates of youth overdoses by race and ethnicity for those with synthetic opioid deaths alone and those with polydrug overdoses involving synthetic opioids. In 2018, more overdoses involved synthetic opioids only than the other examined drug combinations for AI/AN non-Hispanic youth and other non-Hispanic youth. White non-Hispanic, Black non-Hispanic, and Hispanic youth had higher rates of overdose involving a combination of synthetic opioids with some other drug(s) compared with synthetic opioids alone. However, in 2019, Hispanic youth experienced higher rates of fatal overdoses with synthetic opioids alone than polydrug fatal overdoses involving synthetic opioids. By 2020, all racial groups had higher rates of overdose deaths involving synthetic opioids alone than polydrug overdose deaths.

FIGURE 4.

FIGURE 4.

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Rates of overdose by race and ethnicity among those aged 15 to 24 years for those with synthetic-only fatal overdoses (left) and the most common polydrug overdoses involving synthetic opioids (right) in the United States from 2018 to 2022. Some data points are suppressed because of low counts.

Abbreviation: AI/AN, American Indian/Alaska Native.

Overdoses Involving Synthetic Opioids Alone Across Race and Ethnicity

In 2018, Black non-Hispanic youth rates of overdoses involving synthetic opioids alone were 0.38 times that of white non-Hispanic youth (95% CI, 0.28–0.51) (Supplemental Table 4). AI/AN non-Hispanic youth, other non-Hispanic youth, and Hispanic youth also all had significantly lower rates of fatal overdoses involving synthetic opioids compared with white non-Hispanic youth.

However, in 2022, AI/AN non-Hispanic youth fatal overdoses increased to 2.25 times the rate (95% CI, 1.56–3.14) and other non-Hispanic youth overdoses increased to 0.49 times the rate (95% CI, 0.39–0.61) of fatal overdoses involving synthetic opioids only compared with white non-Hispanic youth. Across all years combined, AI/AN non-Hispanic male youths (7.17 per 100 000) and female youths (3.94 per 100 000) had the highest rates of fatal overdoses involving synthetic opioids only compared with other races within their respective sex category (Supplemental Table 5).

Overdoses Involving Synthetic Opioids and Other Substances Across Race and Ethnicity

Black non-Hispanic, other non-Hispanic, and Hispanic youth had lower relative rates of fatal overdoses involving synthetic opioids and heroin compared with white non-Hispanic youth in 2018. By 2022, there were no significant differences in rates of overdoses involving a combination of synthetic opioids and heroin between any race and ethnicity. Black non-Hispanic youth had 1.59 times the rate (95% CI, 1.19–2.09) and other non-Hispanic youth had 0.46 times the rate (95% CI, 0.25–0.78) of fatal overdoses involving synthetic opioids and cocaine compared with white non-Hispanic youth in 2022. AI/AN non-Hispanic had 4.01 times the rate (95% CI, 2.21–6.76), other non-Hispanic youth had 0.30 times the rate (95% CI, 0.16–0.53), and Black non-Hispanic youth had 0.57 times the rate (95% CI, 0.39–0.82) of overdose deaths with synthetic opioids and other stimulants compared with white non-Hispanic youth in 2022. See Supplemental Table 4 for the complete comparison of rates of fatal overdose by race and ethnicity and specific drug combination.

DISCUSSION

This study identifies which specific drug combinations are driving synthetic opioid–involving fatal overdoses among youth across different sociodemographic groups. Unlike prior studies that have examined youth polydrug overdoses,1,22–25 we analyzed mutually exclusive drug combinations to identify the exact drugs noted to be contributing to the overdose. We additionally compared rates of fatal overdoses involving synthetic opioids alone to polydrug overdoses involving synthetic opioids to better understand the landscape of overdose patterns among this population, how it has shifted over time, and how this may inform public health responses to prevent more deaths.

A major finding is that rates of fatal overdoses involving synthetic opioids alone were highest across all 5 years, regardless of age, sex, race and ethnicity, or region. A possible important driver is the increased availability of counterfeit pills containing exclusively illicit synthetic opioids.26 It has been reported that youth are likely to use pills they believe to be prescription drugs, such as oxycodone and benzodiazepines, but in many cases they may be unknowingly contaminated with synthetic opioids.1,4,27 Our findings imply that many such counterfeit pills may not just be contaminated with synthetic opioids but rather contain exclusively synthetic opioids.28–30 Additionally, early in the opioid epidemic, prescription pills were mainly accessible from a family member or friend with a prescription for an acute or chronic condition.31,32 However, with the reduction in the number of opioid prescriptions, the sale of illicit prescription pills has expanded to other sources, such as mainstream social media platforms, increasing the risk of contaminated drugs.33–35 Another important finding is that the highest rates of overdose deaths following synthetic opioids alone involved synthetic opioids with cocaine or another stimulant. Indeed, studies have shown that a significant number of high school and college students use dark web drug markets and social media to purchase substances such as cocaine and other stimulants, including those used to treat attention-deficit/hyperactivity disorder, which are also increasingly becoming contaminated with synthetic opioids.27,36 This trend in high rates of overdoses involving synthetic opioids and stimulants is not unique to youth and has increased dramatically in recent years for all age groups.37 Our findings show that the growing contamination of both opioids and nonopioid drugs is largely driving the increased rates of overdose deaths in youth as well.37

Recent studies have shown that racial and ethnic minoritized groups are being disproportionately affected as polysubstance-involved overdoses increase.38 Specifically, in recent years, non-Hispanic Black, non-Hispanic AI/AN, and Hispanic fatal overdose rates involving a combination of synthetic opioids with cocaine or another stimulant have increased faster compared with white non-Hispanic overdose deaths.39 It has previously been reported that Black non-Hispanic youth have lower prevalence of cocaine use compared with white non-Hispanic youth. However, this prevalence reverses in adulthood, with Black non-Hispanic adults having higher prevalence of cocaine use.40 Researchers have argued that compounding experiences with various forms of racial discrimination and disparities contribute to the increased prevalence of cocaine use among Black adults, with one study finding that racial discrimination is associated with increased lifetime use of cocaine.40,41 We found that patterns of overdose deaths involving a combination of synthetic opioids with cocaine differed slightly across the examined youth racial and ethnic groups. Black non-Hispanic, AI/AN non-Hispanic, and Hispanic youth had higher relative rates of overdoses from synthetic opioids and cocaine compared with white non-Hispanic youth in 2022. With apparent rises in racial discrimination among Black, AI/AN, and Hispanic youth,42 more work is needed to better understand why rates of overdose are rising fastest among communities of color, particularly among AI/AN youth. Specifically, examining the role of racial discrimination and structural racism in drug use and access to harm-reduction and emergency services is crucial to addressing the disparities in overdose death rates.

Finally, regardless of the drug combination examined, male youth had consistently higher rates of fatal overdoses compared with female youth. These findings are consistent with the patterns of overdose deaths seen in adults, in which men may use drugs more frequently or in higher doses than women.43 Even with male youth being the primary at-risk group, female youth are still increasingly being affected by the changing drug supply.

Risk factors for youth substance use differ from those of adults,44 and little research has focused on if the drugs youth are using and drug combinations driving youth overdoses differ from adults. For example, opioid use disorder (OUD) is less prevalent among younger age groups,45 and yet opioid-related overdoses have risen dramatically nonetheless. Our findings emphasize an important need to improve overdose prevention services and interventions for this age group and update interventions based on drugs involved in overdoses. For example, currently, most harm-reduction services targeting people who use drugs have age restrictions for adults aged 18 years or older, limiting younger people from easily accessing evidence-based services such as syringe exchange programs.46–48 For services that do not have age restrictions, youth still face challenges to engaging in harm reduction. Oftentimes, the design and implementation of interventions come from adults without input from youth, leading to a lack of uptake.49 Additionally, like adults, youth may experience intersectional marginalization based on race, gender, and socioeconomic status. Specifically, youth who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ+) and racial and ethnic minorities often face additional discrimination, adding further barriers to services.49 For youth with OUD who remain at great risk for overdose, it is well known that medications for OUD (MOUDs) are rarely used by this age group, with stigma,50 limited availability of youth addiction treatment programs that offer MOUDs,26,51 and an emphasis on behavioral therapy rather than pharmacotherapy52 being persistent challenges.

Improving access to harm-reduction and treatment services for youth is imperative in preventing fatal overdoses. There are a variety of strategies that can be used to engage youth to lower their risk of overdose. Schools are an important setting in which harm-reduction tools such as naloxone and fentanyl test strips can be distributed.53 Some states have policies, such as the California Campus Safety Opioid Act, which requires most state and community colleges to provide overdose prevention education and free naloxone. Others hang boxes with naloxone and training materials next to first aid kits and fire extinguishers in common gathering areas, such as libraries and residence halls.54 However, some schools remain hesitant to visibly promote overdose prevention materials owing to fear of tarnishing the school image. Normalizing the ongoing overdose prevention efforts in schools across the country is needed to relieve schools’ common fear of judgment from prospective parents and students.54 It is also important to acknowledge that youth at the highest risk for overdose often are not engaged in school or university and so distributing harm-reduction tools at other touchpoints, such as places of employment, homeless shelters, child welfare services, or juvenile justice settings, is critical.53 Additionally, substance use and mental health issues often co-occur among youth. Low-barrier mental health services should be offered at all the touchpoint services previously mentioned.26

It is also important that interventions for this age group tailor strategies to different racial and ethnic groups. In addition to age-related barriers to care, experiences with racial discrimination in health care settings and negative experiences with law enforcement may make engaging Black non-Hispanic and Hispanic youth more difficult.55 Prior research has shown that Black non-Hispanic and Hispanic American people are more likely to be incarcerated for drug possession than white non-Hispanic Americans, potentially hindering their willingness to carry harm-reduction supplies such as fentanyl test strips.55,56 Many AI/AN youth experience mental health problems such as depression, childhood trauma, and loss of cultural identity, which is associated with substance use, yet culturally tailored mental health interventions are often hindered by Western care systems.50 Culturally specific awareness campaigns and trusted messengers in the community to help with linkages to harm-reduction services are necessary to improve access to care and reduce stigma in racial and ethnic minority groups.

Our study has several limitations. First, although information on specific drug involvement in drug deaths has generally improved over time,57 there may still be residual misclassification in mortality coding practices. For example, there are limited, relatively broad ICD-10 code categories that cannot clearly distinguish prescription synthetics from nonprescription synthetic opioids. Additionally, there may be inaccuracies when coding multiple specific drugs as the underlying cause of death. For example, if a synthetic opioid, such as fentanyl, is perceived as the primary cause of death, it is possible that other drugs may not be tested or reported in the mortality record. It is important to note that bias in reporting of mortality records, especially among minoritized racial and ethnic groups as has been previously found with medical examiner data.58 However, it is unlikely that misclassification is explaining the full rise in synthetic opioid alone overdoses over time. Second, our study only examined the most common drugs combined with synthetic opioids, and we did not compare these combinations with other drug combinations that do not involve synthetic opioids. Additionally, only sex-based analyses were possible, rather than by gender or sexual orientation. Given the higher risk of overdose in youth who identify as LGBTQ+, this is a limitation of the current available data. Finally, we did not examine youth who may identify as more than 1 race because of small sample sizes. Further research on these groups is necessary to ensure that overdose prevention interventions are even better tailored to better address this problem.

CONCLUSIONS

This study evaluates the role that specific drug combinations involving synthetic opioids play in youth overdoses in the United States and examines these trends by age, sex, race and ethnicity, and region. Our results highlight that although polydrug combinations involving synthetic opioids continue to contribute to fatal youth overdoses, deaths attributed to synthetic opioids alone are becoming increasingly predominant. Additionally, different age, sex, and race and ethnicity groups are being impacted differently depending on the drug combination. These findings shed light on the changing realities and risks of the drug supply and how they impact key demographic groups and the urgent need for education and harm-reduction efforts tailored to youth to prevent further death and suffering among this important and understudied population.

Supplementary Material

Supplement

WHAT’S KNOWN ON THIS SUBJECT:

Youth overdose deaths have remained elevated in recent years. Trends in youth overdose deaths vary substantially across sociodemographic groups. Many youth overdoses involve more than 1 substance, particularly fentanyl and other synthetic opioids.

WHAT THIS STUDY ADDS:

This study identified specific drugs combined with synthetic opioids driving overdoses among youth and how combinations differed across demographic subgroups. Although polydrug combinations involving synthetic opioids contributed to fatal youth overdoses, deaths attributed to synthetic opioids alone were increasingly predominant.

FUNDING:

Dr Krawczyk was supported by the National Institute on Drug Abuse of the National Institutes of Health under award number K01DA055758. Dr Bunting was supported by the National Institute on Drug Abuse under award number K01DA053435. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

ABBREVIATIONS

AI/AN

American Indian or Alaska Native

ICD-10

International Statistical Classification of Diseases and Related Health Problems, Tenth Revision

IRR

incidence rate ratio

LGBTQ+

lesbian, gay, bisexual, transgender, and queer

MOUD

medication for opioid use disorder

OUD

opioid use disorder

Footnotes

CONFLICT OF INTEREST DISCLOSURES: Dr Krawczyk receives compensation for expert witness testimony as part of ongoing opioid litigation. No other authors have conflicts of interest to report.

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