Increases in fentanyl-related mortality among U.S. youths

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Fentanyl is a synthetic opioid that is increasingly killing young people in the United States.  

Epidemiologist Julie Gaither of the Yale School of Medicine reports that the number of fentanyl-related deaths among children and young adults in 2021 was over 1,500—four times the number from 2018. She will discuss her findings on May 1 at the Pediatric Academic Societies conference in Washington, D.C.  When it comes to opioid-related fatalities in this age range in 2021, fentanyl is by far the most common cause of death.

Fentanyl, a synthetic opioid used to relieve pain, is 30-50 times more powerful than heroin, making a considerably less amount fatal. It is also increasingly being identified in adulterated or substituted for the actual medicine in counterfeit prescriptions that are being marketed illegally (SN: 5/1/18).

"That's primarily the story of what's happening among teenagers," says pediatrician and addiction specialist Sarah Bagley of Boston University's Chobanian & Avedisian School of Medicine. They buy and consume fentanyl thinking they are getting heroin or another narcotic. Overdoses occur because "people are not anticipating that they are going to be exposed to fentanyl," the author writes.

Overdose symptoms include drowsiness, incoherence, gurgling or choking noises, and shallow or absent breathing.

"This change in the drug supply, where you just have a much more potent opioid," says Bagley, who was not involved in the experiment.

According to Gaither's findings, the majority of pediatric fentanyl fatalities were the result of accidental overdoses in the household. "For smaller kids, kids who are mobile, they could be taking a drug that's off the floor," she warns. More education is needed to make sure parents know how dangerous fentanyl is and that narcotics "need to be kept out of proximity to a child."

Gaither looked the CDC statistics on infant and child deaths in the United States from 1999 to 2021. She discovered that the rate of infant deaths attributable to fentanyl increased by almost 300 percent over that time, from 0.47 per 100,000 to 1.92 per 100,000. Fentanyl was a factor in the deaths of 40 babies and 93 children aged 1 to 4 in 2021.

The United States Food and Drug Administration (FDA) granted approval for over-the-counter sales of naloxone (a drug that may reverse an opioid overdose) in March; it is likely to be widely distributed by late summer. Naloxone, which comes as a nasal spray, is being distributed at the end of certain communities' trainings on how to administer the medicine.

The opiate antidote, known by its brand name Narcan, "is safe for kids of all ages," according to Gaither. Parents can "reverse the effects of the opioids almost immediately" if they have this medicine on available.

Bagley argues that it is equally crucial to educate young people about Narcan. Teens, in her talks with them, often inquire about ways to ensure the safety of their pals, "which is really wonderful." When talking to kids about the dangers of drug use, it's important to address both their own personal risk and the question of "how do you take care of the people in your life you care so much about and respond if they're in crisis?"