208 - Trends in Substance Use before and during the COVID-19 Pandemic

Poster Number: 208
Publication Number: 208.400

Ian S. Sorensen, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Kalyn C. Jannace, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Apryl Susi, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Elizabeth Hisle-Gorman, Uniformed Services University, Bethesda, MD, United States; Madeline Dorr, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, McLean, VA, United States; Maxwell Ebert, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Jayasree Krishnamurthy, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Cade M. Nylund, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States

Background: The COVID-19 pandemic is a source of unique stressors for adolescents.  Increases in adult substance use and opioid overdoses have been reported. It is unclear if adolescents face similar risks.

Objective: To evaluate trends in substance misuse in adolescents during the COVID-19 pandemic.

Design/Methods: The military health system data repository was used to identify adolescents ages 10-21 between Jan 2019-Apr 2021. ICD-10 codes classified opioid overdoses (OD), opioid abuse, and tobacco, alcohol, cannabis, and other substance use from outpatient and inpatient records. Outcomes were analyzed individually and grouped into any opioid use and any substance use (inclusive of opioids and other substances). Trends were examined monthly over the entire period and then compared in 6-month periods (Oct 2019-Mar 2020 [pre-pandemic (CP0), reference], Apr 2020-Sep 2020 [COVID-19 Period 1 (CP1)], Oct 2020-Mar 2021 [COVID-19 Period 2 (CP2)]. Poisson regression evaluated the overall monthly trend, and changes in opioid overdose for 6-month periods.

Results: There were no changes in overall OD rates, nor when inpatient or outpatient were evaluated separately. Average monthly opioid abuse increased 0.4% (P=.01) over the study period, while CP1 had a decrease 11% (P < .01), and CP2 no change. For any opioid outcome, there is an average monthly increase of 0.4% (P < .01), a decrease of 12% in CP1 (P < .01) and no change in CP2.Tobacco use had an average monthly decrease of 2% (P < .01), decreased in CP1 by 30% (P < .01) and decreased in CP2 by 26% (P < .01). Alcohol use had a monthly increase of 1% (P < .01), decreased in CP1 by 13% (P < .01), and increased in CP2 by 8% (P < .01). There was no significant overall trend for cannabis use, but a decrease in CP1 of 11% (P < .01) and in CP2 a 5% decrease (P < .01). Other substance use had a monthly decrease of 0.4% (P < .01), and an 11% decrease in CP1 (P < .01) and a 10% decrease in CP2 (P < .01). Any substance (all outcomes combined) use had a monthly decrease of 0.3% (P < .01), and in CP1 a decrease of 22% (P < .01) and an 11% decrease in CP2 (P < .01). See figures.Conclusion(s): There are small changes in substance use in adolescents over the pandemic. OD did not increase but opioid abuse increased slightly. Of potential concern is the 8% increase in rates of alcohol over CP2. Pandemic limitations to healthcare access may explain decreases, like tobacco use. Military factors, stable employment and universal access to healthcare, may be protective. There was a lack of expected increases for many categories. As the pandemic continues, providers should keep screening for substance use.
Figure 1: Monthly rate (per 100,000) of opioid and substance use outcomes over study period
Figure 2: Rate ratios of opioid and substance use outcomes comparing COVID-19 Period 1 vs pre-pandemic and COVID-19 Period 2 vs pre-pandemic