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Q&A: US experiencing ‘very concerning’ rise in overdose deaths among adolescents

Counterfeit pills containing illicit fentanyl are driving child and teen overdose deaths which have more than doubled since 2019.

Rose Weldon, Healio, Jan 12, 2024

Overdose deaths among high school-aged adolescents in the United States more than doubled between 2019 and 2020, researchers reported this week in The New England Journal of Medicine.

In a perspective, Joseph Friedman, PhD, MPH, an MS4 at the David Geffen School of Medicine at UCLA, and Scott E. Hadland, MD, MPH, division chief of adolescent and young adult medicine at Massachusetts General for Children and Harvard Medical School, noted that there are 19 hotspot counties in the U.S. that experienced at least 20 overdose deaths and said many adolescents “may be unaware of the proliferation of counterfeit pills.”

We spoke with Friedman about how counterfeit pills make their way to children and what parents and physicians can do to combat the crisis.

Healio: What prompted you to write this perspective?

Friedman: We have been following the very concerning trend of rising overdose deaths among high school-aged teens and wanted to provide a synthesis of the latest numbers alongside targeted advice that physicians, parents, teachers and teens themselves can use to help teenagers stay safe.

Healio: Why have fentanyl deaths increased in recent years?

Friedman: Counterfeit pills containing illicit fentanyl are driving much of this risk. Teenagers are more likely to use pills versus the powder forms of drugs - previously the main source of fentanyl. In 2022, for example, 0.3% of 12th graders reported past-year heroin use, whereas 5.0% reported nonmedical use of prescription drugs. Many adolescents may be unaware of the proliferation of counterfeit pills, believing pills they encounter to be safe.

Healio: Where are the tablets coming from, and how are children getting ahold of them?

Friedman: The pills are coming from the illicit market, not from a doctor. However, they often look identical to the real thing with the naked eye. They are often sold to teens via social media, or passed from one teen to another.

Healio: What can parents do to prevent this from happening?

Friedman: The most important first step is education about the risks. Many teens are simply experimenting with these pills, not realizing the potential risks. Educators and parents can convey clear messages about the risk associated with fentanyl and counterfeit pills. It’s important to highlight that not all substances are equally dangerous. Teens most commonly report experimenting with alcohol, cannabis and prescription pills. Those pills are now in the highest risk category of drugs to try.

Our study identified hotspots of teen overdose popping up all over the country. New hotspots can occur anywhere, so families should not assume that their area is low-risk. A great way to reduce the potential for risk is to provide naloxone - the opioid reversal agent - in schools, alongside education about pills and fentanyl.

Healio: What can pediatricians and primary care providers do to combat this in their practice?

Friedman: Pediatricians, other primary care clinicians, therapists, and any clinician who see adolescents can routinely ask their patients whether they or their peers have been approached about purchasing pills, including on social media, or have used pills that were not prescribed to them. Many pediatricians already universally screen adolescents for substance use, which can serve as an introduction to a conversation about fentanyl. Clinicians can provide adolescents and family members with advice about counterfeit pills, signs of an overdose, and how to intervene in the event of an overdose.

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