AAfter remaining stable for a decade, the overdose death rate among American teenagers nearly doubled from 2019 to 2020 — an alarming rise that has continued through 2021, according to a study released Tuesday.
The reasons do not include an increase in the number of children in this group – aged 14 to 18 – who use drugs, the researchers said. On the contrary, survey data indicates that fewer adolescents have experimented with the drug during the pandemic.
Rather, a major factor is that the supply of increasingly deadly drugs, which has pushed the total number of overdose deaths to more than 100,000 a year, has affected what teenagers use. What teens may think is an opioid painkiller or Xanax diverted from the legal supply is now more likely to be a counterfeit pill containing fentanyl or similar synthetic opioids.
“Drug use is getting more dangerous, not more common” among teens, said Joseph Friedman, a UCLA addictions researcher and lead author of the paper. “To some degree, I think that’s just the national progression of the fentanyl crisis.”
According to the article, published in the journal JAMA, 518 teenagers died of drug overdoses in 2010, a rate of 2.40 per 100,000 people. In 2019, the rate had changed little, at 492 deaths or 2.36 per 100,000.
In 2020, 954 teenagers fatally overdosed, a rate of 4.57 per 100,000. For the first six months of 2021, the rate increased another 20%, to 5.49 per 100,000.
In 2021, the overdose death rate for the general population was 31.06 per 100,000.
Experts polled by STAT had differing interpretations of how the pandemic contributed to the spike in teen deaths in 2020. Some researchers believe the pandemic, by disrupting transportation networks and closing borders, did perhaps only accelerating the toxicity of the drug supply.
There is also the question of whether the disconnection and isolation that accompanies Covid played a role. Teenagers reported large increases in depression and anxiety.
Scott Hadland, the chief of adolescent and young adult medicine at Massachusetts General Hospital, who did not work on the new study, said the pandemic has worsened mental health issues among teens who use drugs and may have caused more frequent use, increasing the risk of tragic outcomes. The pandemic has also interrupted treatment programs.
“Of all my patients with addiction of any kind, and in particular opioid addiction, it really is the rule and not the exception to have co-existing mental health issues,” said Hadland said.
All experts agreed that drug supply was a major issue. The study looked at overdose deaths by type of substance, and all those included – from prescription opioids to benzodiazepines to cocaine – resulted in less than one death in 100,000 people throughout the study period, from 2010 to 2021. The exception was illicit fentanyl and related substances. synthetic opioids. Overdose death rates from these drugs have taken off in recent years, quadrupling from 2018 to 2021.
But if illicit fentanyls have been poisoning the drug supply for years, why is it only in 2020 that their dangers have fully reached teenagers? Experts said it seems to have to do with when extra strong opioids started showing up in other drugs. They infiltrated heroin supplies years ago, for example, but teenagers are more likely to try pills than powder drugs. Only more recently has fentanyl been increasingly found in pill supplies. A separate study published last month revealed that more than a quarter of fentanyl seizures by law enforcement are now in pill form.
Ed and Mary Ternan lost their son Charlie to an overdose in 2020. A college senior who loved movies and music, he took what he thought was a Percocet but was a counterfeit fentanyl pill.
Since then, Ed Ternan said he has spoken with parents who have lost their teenage children to fentanyl-containing pills. The family started an organization called Song for Charlie, which gives presentations “with the warning that the street market and the online market have been completely flooded with these counterfeit pills”, he said. While law enforcement and the media publicized the risks, “information that these pills were available was not reaching the most vulnerable audience, namely children.”
The new study also looked at adolescent overdose mortality by race and ethnicity, and found that some of the disparities in this age group echo those found in adult overdose data. The highest teenage death rate, for example, was in Native American or Alaska Native teens. From 2020the same group had the highest overall overdose death rate – about 30% higher than whites.
There was a noticeable difference. Overall, the Latino community has a relatively low rate of overdose deaths. But, according to the new study, Latino teens had the second highest rate.
Jennifer Unger, a public health researcher at the University of Southern California who did not work on the new study, said one potential reason was the uneven impact of the pandemic. Teens in the Latino community lost more loved ones to Covid and experienced greater financial challenges, which increased the stress they felt.
She said education and awareness campaigns must reach all communities. She did focus groups with the Latino community in Los Angeles, and many people see marijuana as a greater threat than opioids.
“Parents were all worried about their kids using cannabis,” Unger said, “but there are far worse drugs out there.”
Experts said tallying up new data on adolescents is crucial so clinicians and policymakers can better tailor their responses to young people – and ensure the medical community recognizes that some adolescents need specialist treatment for drug addiction. Previous studiesfor example, found that very few adolescents receive medication for opioid use disorder – the gold standard therapy for opioid addiction – even after surviving an overdose. Parents are sometimes skeptical of treatments, and there aren’t many providers who specialize in teen addiction medicine.
Sarah Bagley is an adult internist and pediatrician at Boston Medical Center specializing in addiction care. She said among adults there is a broad push to expand access to medication and to provide the opioid overdose reversal drug naloxone. “And then in the pediatric world, we still have a ways to go,” she said.
To protect teens, advocates say lawmakers should ensure Good Samaritan laws – which protect people who call for emergency help when someone overdoses on a lawsuit – apply to teens . Schools should have naloxone on hand, and teens should be trained to recognize the signs of an overdose and how to use naloxone in their health classes.
Providing such education does not mean more children will use drugs, said Sheila Vakharia, deputy director of research and academic engagement at the Drug Policy Alliance, who has drug education program designed for teenagers. On the contrary, Vakharia said, “they will be better informed to respond appropriately.”