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Introduction: Substance abuse (SA) is a risk factor for stroke. Opioid abuse (OA) can be a precursor for SA, and national prevalence of OA particularly in young stroke patients (YSP) has not been described. We report prevalence and factors associated with OA in YSP. We also explore in-hospital outcomes in YSP with OA.Methods: We identified ischemic stroke, intracerebral hemorrhage, and sub-arachnoid hemorrhage patients and patients abusing Opioids, Cocaine, Alcohol, Cannabis, Amphetamines and Hallucinogens using ICD-9 codes, from the National Inpatient Sample for the years 2006 - 2011. Patients aged 18-45 were categorized as YSP. Logistic regression methods are used. Odds ratios (OR) and 95% Confidence Intervals (CI) are reported.Results: A total of 163 469 YSP were identified. YSP had a significantly higher proportion of SA as compared to non-YSP for all substances (Table 1). Among YSP, 2 320 had been coded for OA. Among OA YSP, 53% patients also abused at least one additional substance. Males were more likely to be opioid abusers (OA) (OR: 1.23, CI: 1.30-1.47) and more OA were in the lower household income group (Table 2). OA was also associated with higher disease severity and mortality risk, likelihood of being on ventilator support, and longer length of stay. Higher proportion of OA was treated at urban and teaching hospitals, and in the Northeast as compared to other national regions. OA had a greater likelihood of in-hospital death (OR: 1.70, CI: 1.24-2.33) and had poorer discharge disposition (Table 1).Conclusions: OA in YSP is associated with greater disease severity, poor in-hospital outcomes including death, and higher utilization of resources. Although OA has not been independently identified as a risk factor for stroke, OA is frequently accompanied by or is a precursor to SA. Routine screening and counselling are required in YSP to prevent recurrence and poor outcomes associated with OA and SA.