Unintentional drug overdose has become a grave and sustained public health burden in the US. 1 The US Centers for Disease Control and Prevention (CDC) defines unintentional drug overdose as occurring "…when no harm is intended." 2(p1) and inclusive of "…overdoses resulting from drug misuse, drug abuse, and taking too much of a drug for medical reasons." 2(p1) Adult decedents have been the focus of most overdose mortality reports, despite the fact that adolescents (aged 10-19 years) and young people (aged 10-24 years) are increasingly dying of unintentional drug overdose. 3 This troubling trend requires further study, given that adolescents and young people are deprived of many more years of work, community life, and family life than are older individuals dying of unintentional drug overdose.To our knowledge, no prior study has assessed unintentional drug overdose mortality among adolescents and young people in years of life lost (YLL). YLL is an epidemiologic descriptor that gives weight to deaths among the young. 4 YLL analysis has the potential to provide important context to the overdose crisis by better representing what is meant to society by the loss of adolescents and young people to unintentional drug overdose. The present work aimed to fill this important gap in the literature by calculating unintentional drug overdose YLL in this vulnerable population.

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Fibromyalgia and opioid use disorder (OUD) are highly impactful chronic illnesses with substantially overlapping psychosocial, biological, and clinical features. Little previous research has examined interactions between fibromyalgia and OUD. Limiting such research has been the previous requirement of a clinical examination to diagnose fibromyalgia. The 2011 American College of Rheumatology Fibromyalgia Survey (ACR-FMS) is a validated self-report instrument with high sensitivity and specificity for fibromyalgia intended to enable fibromyalgia research in settings where a clinical examination is impractical. The present observational study uses the ACR-FMS to determine whether fibromyalgia affects odds of acknowledging pain-related OUD exacerbations among a sample of participants with pain and OUD. Participants with pain and OUD (n = 125) were recruited from an academic substance use treatment facility. The ACR-FMS, along with an original scale measuring pain-related OUD exacerbation—the Pain-related OUD Exacerbation Scale—was administered through an electronic survey. The factor structure, internal consistency, and construct validity of Pain-related OUD Exacerbation Scale were tested. In addition, descriptive analyses, multiple hierarchical linear regression, ordinal logistic regression, and multinomial logistic regression analyses were performed. Although all participants had pain, those with fibromyalgia demonstrated significantly greater odds of acknowledging pain-related OUD exacerbations. Pain-related OUD Exacerbation Scale was found to have a single-factor solution, strong internal consistency, and construct validity. This study provides first evidence of fibromyalgia as a risk factor for pain-related exacerbation of OUD and introduces a new scale with promising psychometric properties to measure pain-related OUD exacerbation.

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