Adolescent Overdose Deaths Double Since 2010

Overdose deaths among adolescents doubled from 2010 to 2021, with much of the increase occurring in recent years because of fentanyls, a study in JAMA has found. The study also revealed that adolescent overdose deaths rose more than 20% in the first six months of 2021.

The findings run counter to an overall downward trend in adolescent substance use, said lead author Joseph Friedman, Ph.D., M.P.H., a medical student and researcher at the University of California, Los Angeles.

“Adolescent drug use rates have actually gone down a lot in recent years, so this is not about teen drug use becoming more common; rather it’s becoming more dangerous,” Friedman told Psychiatric News.

Friedman and colleagues used data from the Centers for Disease Control and Prevention to calculate the rate of overdose deaths in adolescents aged 14 to 18 years from January 2010 to June 2021. In 2010, there were 518 overdose deaths among adolescents, and the overdose death rate in this population remained stable through 2019, when there were 492 adolescent overdose deaths. However, adolescent overdose deaths increased to 954 in 2020 and further increased to 1,146 in 2021. Overall, adolescent overdose deaths increased 94% between 2019 and 2020 and increased 20.05% from 2020 to 2021.

Adolescent overdose deaths involving fentanyls increased from 253 in 2019 to 680 in 2020 and 884 in 2021. In 2021 fentanyls were involved in 77.14% of adolescent overdose deaths, compared with 13.26% for benzodiazepines, 9.77% for methamphetamine, 7.33% for cocaine, 5.76% for prescription opioids, and 2.27% for heroin.

“Illicitly manufactured fentanyls have been driving overdose deaths in adults for more than a decade, but now they are being added to counterfeit pills. While adolescents do not report much experimenting with heroin, they do experiment with pills,” Friedman said.

The highest rates of adolescent overdose deaths occurred in adolescents who were American Indian or Alaska Native, followed by adolescents who were Latinx.

“We need more targeted research to say why this is, but in general, as the drug supply becomes more dangerous, it increasingly affects minoritized communities that are more vulnerable,” Friedman said.

Friedman noted that patterns of overdose death in adolescents tend to differ from those in adults.

“With adults we are used to thinking about substance use disorders, but with adolescents in many cases it stems from just experimenting. They may experiment only a few times with counterfeit pills before tragedy strikes,” he said.

Addressing the issue starts with drug education, Friedman added.

“In the United States, we have been teaching abstinence-only drug education for decades, but despite that, many adolescents still report experimenting with illicit drugs. Telling them to ‘just say no’ isn’t really helpful,” he said. “Yes, it is important to teach kids that abstinence is the best option, but it’s also important to teach them why.”

To that end, drug education can include a discussion of how studies have shown that postponing substance use until the early 20s is associated with fewer bad outcomes, Friedman said.

“You can say, ‘While most Americans will eventually experiment with illicit drugs, we know it’s better to wait and make this decision when you’re older,’ ” he explained, adding that it can be valuable to educate adolescents about how various substances differ from one another. “You can explain that not all drugs are equal, and that while cannabis and alcohol also have their risks, they have never been shown to be contaminated with fentanyls.”

This study was supported by the National Institute of General Medical Sciences, the National Institute on Drug Abuse, and the Korein Foundation. ■