Fentanyl deaths have spiked among U.S. children and teens

The rise in kids’ deaths from the synthetic opioid mirrors what’s happening with adults

A wall of posters on a bulletin board in a classroom, one of which reads 'NALOXONE CAN SAVE YOU'

In an opioid overdose prevention class in New York City in 2017, students received training in how to use naloxone. The medication blocks the action of fentanyl, reversing an overdose.

Spencer Platt/Getty Images

Fentanyl, a deadly synthetic opioid, is killing a growing number of children and teens in the United States.  

More than 1,500 kids under the age of 20 died from fentanyl in 2021, four times as many as in 2018, says epidemiologist Julie Gaither of the Yale School of Medicine, who will present the data May 1 at the Pediatric Academic Societies meeting in Washington, D.C.  The fentanyl deaths account for nearly all of the opioid-related deaths in this age group in 2021.

Fentanyl is a lab-made opioid used for pain treatment that is 30 to 50 times more potent than heroin, making it lethal at a much smaller dose. The drug is also manufactured and sold illegally and is increasingly found contaminating counterfeit prescription drugs, or entirely replacing the drug a buyer expects to get (SN: 5/1/18).

“That’s primarily the story of what’s happening among teenagers,” says pediatrician and addiction provider Sarah Bagley of the Boston University Chobanian & Avedisian School of Medicine. They intend to purchase and use one kind of drug or substance but unknowingly ingest fentanyl. “People are not anticipating that they are going to be exposed to fentanyl, and then they are, and that results in an overdose.”

Some of the signs that a person is experiencing an overdose include falling asleep, losing consciousness, gurgling or choking sounds and weak or no breathing.

“This change in the drug supply, where you just have a much more potent opioid, is really driving it all,” says Bagley, who was not involved in the work.

Many of the fentanyl deaths among children and teens occurred at home and the vast majority were accidents, Gaither reports. “For smaller kids, kids who are mobile, they could be taking a drug that’s off the floor,” she says. There needs to be more education so that parents understand how lethal fentanyl is and that drugs “need to be kept out of proximity to a child.”

Gaither analyzed pediatric mortality data collected by the U.S. Centers for Disease Control and Prevention from 1999 to 2021. The mortality rate from fentanyl soared more than 300 percent during that period, from 0.47 per 100,000 children to 1.92 per 100,000, she found. In 2021, 40 infants and 93 children 1 to 4 years of age died from fentanyl.

Fentanyl deaths have also been climbing for adults. More than 70,000 deaths in the United States were due to synthetic opioids, primarily fentanyl, in 2021, out of over 106,000 drug overdose fatalities reported that year.

Naloxone, a medication that can reverse an opioid overdose, was approved for the over-the-counter use in March by the U.S. Food and Drug Administration and is expected to be available at a variety of stores in late summer. Some communities have been holding trainings on how to administer the medication, which comes as a nasal spray, and conclude by distributing naloxone to participants.

Sold under the brand name Narcan, the opioid antidote “is safe for kids of all ages,” Gaither says. If parents have the medication on hand, they can “reverse the effects of the opioids almost immediately.”

It’s important to also raise awareness of Narcan among teenagers, Bagley says. In conversations she’s had with teens, they have a lot of questions about how to keep their friends safe, “which is really wonderful.” Discussing overdoses with teens can include talking about an individual’s risk as well as “how do you take care of the people in your life you care about so much and respond if they’re in crisis.” 

Aimee Cunningham is the biomedical writer. She has a master’s degree in science journalism from New York University.

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