California young adult mortality rate above pre-pandemic levels, fueled by overdoses

A new report from California’s Legislative Analyst’s Office shows that the young adult mortality rate has remained much higher than pre-pandemic levels.

“Overall mortality among Californians between the ages of 15 and 44 is still much higher than it was before the COVID-19 pandemic,” reads the report. “In 2023, 15-to-44-year-old Californians (to whom we refer as “young adults” in this report) died at a rate of 128 per 100,000 people, compared to just 99 per 100,000 in 2019—representing an increase of nearly 30 percent.”

Notably, 60% of deaths among those aged 15 to 44 are from overdoses - a sharp increase in 2020 fueled by the prevalence of fentanyl.

“Age 15 to 44 drug overdose deaths were growing before the pandemic, but this growth accelerated substantially in early 2020,” reads the report. “Since then, this growth has slowed but not reversed, so young adults are still dying from overdoses at a much higher rate than before the pandemic.”

Prior to 2020, young adult overdoses usually involved synthetic opioids - not psychostimulants. However, after 2020, overdoses have been driven primarily by a mix of synthetic opioids and psychostimulants with 95% of those deaths involving fentanyl.

“Due to fentanyl’s low cost, high potency, and ubiquity in drug markets, people often intentionally or unintentionally use it along with other drugs,” reads the report. “As a result, many fentanyl overdose deaths involve other drugs as well. One of the most common pairings consists of fentanyl and a psychostimulant, typically methamphetamine… this pairing of drugs has played a large and growing role in the fentanyl overdose crisis.”

In addition to the available quantity of fentanyl, the report notes two other things that may be contributing to the increased number of overdoses - declining participation in medication-assisted treatment for opioid use and increased homelessness among young people. Medication-assisted treatment is where buprenorphine, methadone and naltrexone is used to block the effects of opioids and reduce cravings and withdrawal symptoms.

“Enrollment in these programs was 42 percent lower in March 2020 than in March 2019,” reads the report. “These enrollment numbers rebounded by March 2021 but still remain noticeably below pre-pandemic levels. This pattern suggests that early-pandemic changes in access to medication-assisted treatment might have contributed to the rapid growth in overdose deaths in 2020.”

While substance abuse is prevalent among the homeless population, the report notes that the rate of overdose deaths among the homeless has grown much faster than the homeless population itself.

“Among people experiencing homelessness in Los Angeles County, the total number of overdose deaths grew from 341 in 2019 to 826 in 2022—an increase of 142 percent,” reads the report, concluding that easy access to fentanyl is the more likely contributor to overdoses.

“These numbers suggest that most of the county’s growth in overdose deaths has not occurred simply because more people are living on the streets,” reads the report. “Rather, other factors that affect the risk of overdose death both for housed and unhoused people—such as the pervasive presence of fentanyl—appear to be more important.”

The other types of young adult deaths are alcohol-induced (10%), motor vehicle crashes (10%), firearm homicides, Covid-19 and other causes of death.

Based on these findings and the high number of young adult deaths, the Legislative Analyst’s Office urges the legislature to explore ways to reduce the young adult mortality rate.