Recent research has shown that teen overdose deaths have increased exponentially in the last few years. However, drug use among adolescents has remained relatively stable if not declined. Researchers believe that drugs are becoming more potent and dangerous to take.

We need to understand why teen overdose deaths are increasing and what we can do to prevent it. If you have teenagers, speaking to them about drug use and how they can take them more safely could be vital in keeping them safe and knowing when to pursue professional help for drug misuse.

Mortality Rates from 2010 to 2021
Between 2010 and 2019 adolescent deaths due to overdose remained relatively stable going from 518 to 492 deaths. However, from 2019 to 2020, there was a huge increase, with 954 adolescents dying from overdoses in 2020, 4.57 per 100,000. The statistics from 2021 have not been fully analyzed but provisional data suggests that 1146 adolescents died in 2021.

Increased mortality is also seen in the general population with death rates increasing by a factor of five from 2003 to 2020. This research showed that the death rate is peaking at lower ages, currently peaking in the mid-thirties.

Has Adolescent Drug Use Increased?
A natural assumption would be that increased adolescent mortality from overdosing is caused by increased drug use among teens. However, the percentage of 8th, 10th, and 12th-graders who use illicit drugs has fallen from 2011 to 2021. For example among 12th-graders in 2011, forty percent reported to have used illicit drugs in the last twelve months. This fell to thirty-seven percent in 2020, and to thirty-two percent in 2021. The evidence would suggest that it is not increased drug use which is leading to the rise in teen overdose death rates.

The Rise of More Dangerous Drugs
Researchers think that the increased death rate is, instead, related to drugs becoming more dangerous in recent years. A new study by UCLA Health has shown that the street drug supply has become contaminated with illicitly manufactured fentanyl and other synthetic opioids. This is consistent with seventy-seven percent of adolescent overdose deaths involving fentanyl in 2021. The mortality rate of these sorts of substances increased by 169 percent from 2019 to 2020.

Teenagers may buy a pill which looks like Oxycontin, Xanax, or Adderall without knowing that it has been made illicitly. These pills are pressed so that they look real and it can be very difficult to tell the difference between them and the legitimate form.

What is Fentanyl?
Fentanyl is a powerful synthetic opioid painkiller. It acts on opioid receptors in the brain causing euphoria and pain relief. It is used to treat patients with severe pain such as after surgery and also to treat chronic pain in patients who are tolerant to other opioids.

Fentanyl is up to fifty times more potent than heroin and one hundred times more potent than morphine. This means that a much smaller dose is needed to have effects and also to overdose. 

As little as 2 mg of fentanyl can be a lethal dose depending on the person. Factors which affect this include weight, tolerance to opioids, and past usage. In 2021, law enforcement seized 10 million pills compared to 300,000 in 2018. The Drug Enforcement Administration (DEA) has reported that four out of ten pills contain at least 2 mg of fentanyl.

Finding A Solution
The increase in adolescent overdose death rates is extremely worrying. Joseph Friedman, the lead author in the study, has stated that when overdose death rates increase exponentially after having been stable, they tend to continue to increase in this way for some time. It is therefore vital that action is taken in order to reduce the harm which is being done to teenagers in the USA.

Policy makers are pushing to disrupt the supply of these drugs. However, this is a slow process. If deaths continue to rise exponentially for some time, hundreds or even thousands more teenagers may die before any change is seen. Fentanyl is cheap to produce and a small amount goes a long way so other options are needed for more immediate results.

Harm Reduction
Creating Open and Honest Communication
Parents often worry that speaking with their teenagers about drugs and safe drug use could result in them taking them. However, harm reduction does not mean enabling drug use. It may be tempting to tell your teens that taking ecstasy or other pills will cause death; however, when they see that friends or school mates have taken pills without dying, they may start to doubt the truth of what you say and turn to peers or the internet for advice.

You should teach your teenagers about the risks of drug taking and how to take drugs more safely. Making them aware of the fact that pills bought from the street are likely to contain fentanyl may stop them from taking them or make them more careful about buying pills. While teaching teens about safe drugs should not increase their chances of taking drugs, it will mean that if they do, they will take them more carefully and will be more open with you about it. Creating a space in which your teenagers feel safe to ask you questions and ask for help if they need it is important.

Fentanyl test strips can help with more careful drug use. They are used to detect traces of fentanyl in a batch of drugs before you take them. However, despite there being evidence that the strips lead to more careful drug use, they are not widely available. Advocating for more available fentanyl test strips could help to reduce the number of adolescent overdoses across the US. 

It is also important that states and schools do more to keep teens safe. Naloxone is a medicine which is used to rapidly reverse the effects of opioid drugs including fentanyl. In 2020, at least 20 states did not require that schools keep naloxone in stock. They also did not require that the school nurse or other employee know how to administer the drug. It is important that naloxone is made available in schools so that they are available in spaces which teenagers go.

According to Friedman teenage overdose mortality may continue to increase. We must therefore be open to speaking with teenagers about what they are going through and advocating for safe drug use. Incarceration will not be the answer.