P3.006: Characteristics of Adolescents Presenting to a Children’s Hospital for Acute Care with Alcohol, Benzodiazepine, and/or Opioid Use-Related Concerns

Background: Drug-related overdoses are the third leading cause of death among children and adolescents in the United States. Despite this risk, existing literature regarding the characteristics of adolescents presenting for acute care secondary to intoxication and withdrawal is scarce. The purpose of this study was to identify risk factors that may be linked to higher rates of severe substance misuse and mortality.

Methods: We conducted a retrospective chart review including adolescents 11-21 years of age who presented to the Children’s Hospital of the King’s Daughters (CHKD) Emergency Department or PICU for an alcohol, benzodiazepine, and/or opioid-related acute care encounter between January 1, 2021, to December 31, 2023. The primary outcome measure was the pattern of substance use described. Secondary measures included 1) the prevalence and type of EMR-identifiable risk factors for high-risk substance use and unintentional overdose mortality and 2) patient readmission and mortality rates.

Results: Our sample included 69 patients, 55% female, with most visits occurring among 15 to 17 year olds. The most common diagnosis was alcohol abuse with intoxication. Primary substance was most commonly alcohol (61%), followed by opioid (26%) and benzodiazepine (13%); marijuana was the most frequently co-abused substance (52%). Common antecedent risks included parental/family history of substance abuse (46%) and history of abuse or neglect (30%), whereas coincident risks included school truancy/suspension (51%) as well as larceny, sexual promiscuity, and drunk-driving. Forty-six percent of patients were found to have major depressive disorder or depressed mood. Three patients (4%) died secondary to complications from alcohol intoxication and opioid overdose, including fentanyl. Two of the 3 had an acute positive suicide screen indicating imminent risk (compared to 21% overall), and subsequently died of recreational drug use after discharge from rehab. The readmission rate was 12%.

Conclusion: Our study demonstrated that alcohol intoxication and opioid overdose were associated with mortality in pediatric patients presenting acutely due to substance use. In addition, data from this study raises concerns that higher suicide risk scores may be associated with increased risk-taking behavior that could lead to death. However, the sample size was small, which highlights the need for further study to aid in refining risk stratification protocols in pediatric hospital systems, improving mental health supports, and reducing mortality rates.