Many U.S. teens underestimate fentanyl’s deadly risk

Using the synthetic opioid once could be lethal, but many adolescents aren’t aware of the danger

Behavioral health fellow Leah Hill of the Baltimore City Health Department discusses how to reverse an opioid overdose with naloxone nasal spray in 2018. Many U.S. middle and high school students don’t realize that the synthetic opioid fentanyl poses a great risk even when using it once or twice, researchers report.

AP Photo/Patrick Semansky

By Aimee Cunningham

July 7, 2026 at 11:00 am

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The powerful synthetic opioid fentanyl can kill with one use. Yet a sizable percentage of adolescents aren’t aware of this danger.

A majority of 8th-graders and roughly a third of 10th- and 12th-graders do not see a great risk with using fentanyl once or twice, researchers report July 7 in JAMA Network Open. The data come from the 2025 results of the Monitoring the Future study, an annual, representative, long-term study of the behaviors and views of U.S. middle and high schoolers, including on drug and alcohol use.

Drug poisonings and overdoses rank third among the leading causes of death for kids and teens in the United States. Although fewer adolescents are using illicit drugs overall, a growing percentage are dying from overdoses. And fentanyl plays a role in at least 75 percent of overdose deaths among adolescents.

Fentanyl is up to 50 times more potent than heroin and can be lethal in small amounts. The most common route of fentanyl exposure for adolescents is unintentional and occurs by taking counterfeit prescription drugs, which are commonly contaminated with the opioid or made entirely of fentanyl.

For the first time in the most recent Monitoring the Future survey, respondents were asked about how risky fentanyl is — ranging from no risk to great risk — depending on how often it is used: experimentally (once or twice), occasionally or regularly. Respondents could also reply that they didn’t know enough about the drug to say. Among the close to 4,000 students who answered questions on fentanyl’s risk, 48 percent of 8th-graders, 64 percent of 10th-graders and 70 percent of 12th-graders responded that there is great risk with using fentanyl once or twice.

Those who responded that fentanyl posed a great risk grew when asked about more frequent use. But while the concept of increasing risk with rising use applies to some substances, such as alcohol, smoking and marijuana, it’s not the right framing for fentanyl, which can be fatal with one exposure. Adolescents also responded that they aren’t familiar with fentanyl in similar numbers to those who don’t know much about heroin, in the 9 to 17 percent range, depending on the grade. The research suggests that many adolescents aren’t aware of the dangers of fentanyl and other opioids, the study authors note.