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The synthetic opioid fentanyl is killing increasing numbers of U.S. kids, emulating the chilling trends seen among adults, a new study finds.
Pediatric deaths from fentanyl increased more than 30-fold between 2013 and 2021, according to study author Julie Gaither, an assistant professor of pediatrics at the Yale School of Medicine.
Nearly half of the deaths occurred at home, and most were deemed unintentional. Teens may not have known the drugs they were using were contaminated with fentanyl, while very young children may have touched or swallowed drugs used by their parents.
"The problem is that more adults are exposed to fentanyl now, whether it's a pure form of the drug or it's being cut into other drugs, so kids are more likely to be exposed to it," Gaither explained.
Using death certificate data from the U.S. Centers for Disease Control and Prevention, Gaither assessed deaths from fentanyl over two decades.
Almost 5,200 deaths among nearly 14,000 fatal opioid poisonings between 1999 and 2021 were due to fentanyl, Gaither found.
In 1999, about 5% of the deaths from opioids were from fentanyl; by 2021, that had jumped to 94%, mirroring the pattern of adult fatalities.
Earlier this month, a CDC report disclosed that fentanyl overdose deaths in the United States had soared 279% in just five years.
In Gaither's research, she found that a surge in fentanyl-related fatalities that began in 2018 led to a nearly threefold increase in deaths among older teens and a nearly sixfold increase among children younger than 5.
Deaths peaked in 2020 and 2021, Gaither said, suggesting the COVID-19 pandemic made the fentanyl crisis worse.
Nine in 10 of these deaths were among teens ages 15 to 19, and nearly 7% were among kids under 4.
In 2021 alone, fentanyl caused 40 infant deaths and 93 deaths among kids aged 1 to 4, according to Gaither's report.
"There is a general consensus that the overdose deaths involving fentanyl among kids, whether young kids or teens, are primarily unintentional," said Linda Richter, senior vice president at the Partnership to End Addiction.
"Among younger children, access to pills or substances laced with fentanyl that are left within their reach is the main culprit," said Richter, who was not part of the new research.
"For older adolescents, the culprit is more likely a lack of awareness that the pill they are intentionally taking contains fentanyl," she added.
According to Richter, "this analysis adds to the growing body of studies showing just how pervasive and tragic the fentanyl crisis is."
While most fentanyl-related deaths among infants and toddlers are accidental, sometimes these kids are given the drug as a way to get them to sleep or stop acting out, Richter said.
"It's really hard to get data on exactly what happens with the younger kids, but anecdotal evidence is that it only takes a small amount to be deadly. So small kids can touch the drug and then put their fingers in their mouths," Gaither said.
The new report found that between 2013 and 2021, the fentanyl-related death rate increased by 3,740%, from .05 per 100,000 to 1.92 per 100,000.
For teens 15 to 19, the fentanyl-related death rate between 2018 and 2021 rose 290%, from 1.67 per 100,000 to 6.5 per 100,000.
Among children up to 4 years old, fentanyl-related fatalities rose 590% during that time frame, from .10 per 100,000 to .69 per 100,000.
"Few people who hear about drug overdoses involving fentanyl would imagine that babies and toddlers are falling victim to this deadly drug, let alone the staggering increase in deaths among teenagers," Gaither added.
These data show that in some of the fentanyl-related deaths among teens, other substances such as benzodiazepines and cocaine were involved, suggesting either that these drugs were cut with fentanyl or that the teens had other substances in their system at the time of death, Richter said.
Gaither found, for instance, that fentanyl plus benzodiazepines were involved in 17% of the overdose deaths.
"Another recent analysis similarly found that adolescent overdose deaths in the United States more than doubled from 2010 to 2021, with fentanyl involved in more than 77% of these deaths," Richter said.
Overall drug use among teens is not on the rise, Richter noted. "In fact, it's lower than in the past, which suggests that fentanyl is appearing in counterfeit pills that some young people who do use drugs are taking, leading to unintentional overdoses and deaths."
What's needed now?
A multi-pronged approach is needed to reduce deaths from fentanyl, Richter said.
"In addition to addressing the contamination of the drug supply with deadly fentanyl, we need a broad education effort for adults and teens about the proliferation of fentanyl in the drug supply and its lethal potential," she said.
Also, parents must be educated about the need to store all substances and medications out of sight and reach of children and to safely dispose of those no longer used, Richter said.
"Availability of fentanyl test strips for people who do use drugs and a wide scale campaign to have Narcan [naloxone] available in homes, schools and all public places in the event of an overdose is also needed," she said.
The government should ensure that Narcan is free or affordable to anyone who wants it, that the public is trained in its use, and that stigma around its purchase and use is reduced, Richter added.
"Most importantly, we need better substance use prevention and more accessible treatment for those who use drugs in order to reduce the likelihood that they will take a drug that contains fentanyl or have those drugs within reach of children in the home," she said.
Gaither agreed that Narcan is a valuable tool.
"This epidemic is rapidly evolving, so it's just hard to tell what's going to happen, but Narcan can make a huge difference, I believe if it's made more widely accessible," she said.
The report was published online May 8 in the journal JAMA Pediatrics.
SOURCES: Julie Gaither, PhD, MPH, RN, assistant professor, pediatrics, Yale School of Medicine, New Haven, Conn.; Linda Richter, PhD, senior vice president, Prevention Research and Analysis, Partnership to End Addiction; JAMA Pediatrics, online, May 8, 2023
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