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Teen drug overdose deaths rose sharply in 2020, driven by fentanyl-laced pills

Teens started dying in greater numbers from fatal drug overdoses in 2020, raising alarm that the trend could continue or worsen.
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Teens started dying in greater numbers from fatal drug overdoses in 2020, raising alarm that the trend could continue or worsen.

For the first time in a decade, overdose deaths among teens in the United States rose dramatically in 2020 and kept rising through 2021 as well. That's according to the results of a new study published Tuesday in JAMA.

"This is very alarming because what we've seen in other parts of the population is that when overdose death rates start to rise, they tend to continue to do so for quite some time," says Joe Friedman, a public health researcher at the University of California, Los Angeles, and the lead author of the new study.

"We're still really in the early days in terms of teen overdose. And that makes this an especially important time to intervene," he adds.

Friedman and his colleagues found that fatal overdoses among adolescents nearly doubled from 492 in 2019 to 954 in 2020, an increase of 94%. There was an additional 20% rise in 2021 compared to the previous year. The highest rates were among Native American and Alaskan Native teens, followed by Latino teens.

"For decades, we've seen overdose rates rising among adults, and teens have been insulated from that," says Friedman. "And now, for the first time, the overdose crisis is reaching teens as well."

It appears that the rise in deaths was fueled not by greater numbers of teens using drugs – substance use in this age group actually went down during the pandemic – but by use of dangerous and highly potent forms of fentanyl. The study found that fentanyl-related deaths increased from 253 in 2019 to 680 the following year. And in 2021, 77% of all teen overdose deaths involved fentanyl.

However, unlike in adult overdose deaths, it's not fentanyl in heroin that's responsible for the deaths among teens, says Dr. Nora Volkow, director of the National Institute on Drug Abuse, who wasn't involved in the new study.

"Teenagers don't seek out illicit opioids, [but] they do seek out prescription opioids and that has always been one of their favorite drugs: Vicodin, OxyContin, hydrocodone," she says. "And they also seek out benzodiazepines."

And they often end up buying counterfeit versions of these medications – fakes that look like the commonly used prescription medications – which have increasingly become contaminated with fentanyl in the past couple of years.

"It is estimated that at least one third of those illicitly manufactured pills are contaminated with fentanyl," says Volkow, something that most teenagers and their families are unaware of.

"In the past, you would just get sedated," she adds. "Now you can take one benzodiazepine, one pill and it can kill you."

This means that occasional or recreational users can be at risk of dying, says Sheila Vakharia, deputy director of the department of research and Academic engagement at the Drug policy Alliance.

That's why there's an urgent need to better educate teens about the risks of counterfeit pills and give them tools to help them use safely, she says.

Friedman agrees: "It's pretty clear that teens don't understand that many of the pills that are available right now on the street are actually counterfeit [and containing fentanyl]."

It's also important to educate them that not all drugs are equally dangerous, he adds. "Alcohol and cannabis are not risk free, of course. But we know that those drugs have never been found to be contaminated with fentanyls, whereas pills and powders are at a very high risk of being contaminated."

Vakharia says it's important to give kids more information about drug use.

"So many of our young people are so busy being taught to not use drugs that when they are exposed to them or they're surrounded by it, they actually have very little information to go off of to keep themselves or their friends safe around the decisions they make surrounding drugs," says Vakharia,.

Vakharia and her colleagues have developed a school curriculum called Safety First, which teaches youth about the risks of drug use and how to identify signs of an overdose and how to address it.

Pilot studies of this curriculum in schools around the country revealed that students who took this training knew the signs of an overdose and how to respond to it, says Vakharia.

She adds that schools need to play an important role in addressing this, not just by adopting curricula like the one she and her colleagues created, but also by making naloxone, the overdose medication, easily available to their students.

"Naloxone ... is an incredibly safe medication that we'd love to see in school first aid kits," she says. "And to be getting our young people trained on these medications and using this medication for an overdose."

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Rhitu Chatterjee is a health correspondent with NPR, with a focus on mental health. In addition to writing about the latest developments in psychology and psychiatry, she reports on the prevalence of different mental illnesses and new developments in treatments.