BACKGROUND AND OBJECTIVES: The United States has been experiencing a deadly epidemic of fatal drug overdose (OD), including among emerging/young adults. We aimed to examine intentional OD (IOD) among young adults receiving methadone maintenance treatment for opioid use disorders (OUD). METHOD: Thirty-three participants (18-26 years old) with OUD completed measures of drug use, OD, depression, and suicidal behavior. Between-group differences were analyzed using independent samples t-test and χ² test for continuous and dichotomous data, respectively. Regression analysis was employed to predict the magnitude of intent to die before the most recent OD. RESULTS: Forty-two percent of the sample had a history of a suicide attempt (SA). Of those, 78% reported >
1 IOD. Participants with SA history had a significantly higher depression severity (p = .01), were younger at the onset of opioid use (p = .04) and were less likely to be Hispanic (p = .03) relative to those without SA history. The magnitude of intent to die before the most recent OD was predicted by (a) number of lifetime SAs (p <
.001), (b) likelihood that participant thought they would OD before their most recent OD (p = .009), and (c) number of days using illicit opioids in the last 30 (p = .02). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: These findings indicate a high prevalence of IOD among young adults enrolled in clinical services. Awareness of suicidal intent as a predictor of OD would improve prevention-intervention methods for the reduction of morbidity and mortality among them. This is the first reported study to examine IOD among emerging/young adults with OUD.