Teen overdose deaths from fentanyl are rising. Here's what parents need to know

According to the Journal of the American Medical Association (JAMA), there were 884 teen overdose deaths from illicit fentanyls and synthetics in 2021, up from 680 in 2020 and 253 in 2019. In 2021, fentanyl was identified in more than 77% of teen overdose deaths.

Teen deaths from fentanyl are spiking in part because the drug can show up almost anywhere, often without teens knowing.

“Fentanyl is sometimes present in party drugs like cocaine [or] methamphetamine,” says John Tsilimparis, a psychotherapist and mental health consultant with a specialty in addiction and recovery.

Fentanyl is much less expensive than other drugs, so dealers increase their profits when they use fentanyl instead of the drug they claim to be selling.

In California, the County of Santa Clara has launched a campaign that warns residents to “expect fentanyl” whenever they use any type of illicit substance, noting that marijuana is sometimes cut with fentanyl and that it has been found in pills that look almost identical to prescription drugs. The Drug Enforcement Agency (DEA) has also launched a public awareness campaign warning that “One Pill Can Kill.”

Tsilimparis says that “no one has yet found a way to eliminate youthful risk-taking, impulsivity and curiosity when it comes to mood-altering substances, but we can reduce the odds via education as well as recognizing the environmental risk factors.”

What is fentanyl?

Aaron Sternlicht, an addiction specialist and co-founder of Family Addiction Specialist, explains that although fentanyl is an opioid, it’s more dangerous than other drugs in the same class because it’s far more potent.

“For context, it is 50 to 100 times stronger than many other opioids such as morphine,” says Sternlicht, who adds that fentanyl is most commonly used by doctors to treat severe pain and advanced cancer.

According to Tsilimparis, synthetically produced street fentanyl, which teens may unknowingly take instead of the prescription version, “can be hundreds of times stronger than Oxycodone, Norco or Percocet, which are regularly used prescription opioid drugs.”

One danger posed by fentanyl use is that users develop a tolerance, meaning that they will need higher doses to achieve the same effect, says Sternlicht. Another is that “over time the brain becomes dependent on the substance to induce pleasure," Sternlicht explains, which means that users will rely on the substance to feel "normal."

JAMA notes that illicit fentanyl has highly varied potency, meaning that a teen who tolerated taking fentanyl once may get a much stronger drug the next time — or that the first dose could be fatal.

Sternlicht says fentanyl kills by slowing the central nervous system, "resulting in slower breathing and heart rate, which can ultimately come to a stop. As the central nervous system slows, the amount of oxygen that reaches the brain decreases, which can lead to coma, brain damage or death.”

What are signs of fentanyl use?

Signs of fentanyl use vary. Sternlicht explains that they include sudden changes in mood, changes in sleeping and eating or hygiene habits, and loss of interest in hobbies or social activities people used to enjoy. Other signs of fentanyl use include lying, stealing, hiding and engaging in secretive behavior, particularly if that involves a change in schedule leading to more time spent outside the house.

Blythe Archer, a former teen addict and current director of business development and admissions for Soul Surgery Rehab, adds that teens constantly asking for money is another red flag. Physical signs of fentanyl use include “dilated pupils, nodding off, excessive itchiness, weight loss and recurring flu-like symptoms,” says Sternlicht.

How should parents talk to their kids about the risks?

Sternlicht says that it’s important to discuss the dangers of fentanyl use with teens, and that those conversations should be ongoing. Because fentanyl is so prevalent, deadly and hard to detect, parents should have these conversations even if they think their kids would never use drugs.

“When you discuss the dangers of fentanyl use … you can share that many individuals who die from fentanyl overdose were never aware that they were using fentanyl because it’s commonly mixed in with other drugs such as cocaine, heroin and even pills," Sternlicht advises. "You don’t have to pretend to be an expert, and if there are questions they ask that you don’t have the answer to, you can do research together with them." He also recommends setting appropriate boundaries and consequences around alcohol and drug use, while being respectful of your teen.

Tsilimparis emphasizes that “the important factor is to educate [teens] by earning their trust. Being respectful and honest rather than simply trying to intimidate them and instill fear [will] be far more effective. Instilling fear means young people will definitely tune out the adult and become defiant with age-appropriate resistance,” he says. If that happens, “the potentially life-saving message will not be absorbed and the intention misunderstood.”

Sternlicht says, that, aside from talking, one of the most important things parents can do is model healthy behavior. “This means engaging in healthy activities such as exercise, proper nutrition, sleep hygiene and other forms of self-care. Children who have healthy role models and practice healthy behaviors themselves are less inclined to use drugs,” he explains.

What role is social media playing?

Andrew Selepak, a social media professor at the University of Florida, says that “young people are going to buy drugs and use drugs by convenience.” For some teens that means seeking out someone they meet at school or a party, and for other teens that may mean buying drugs through social media.

The content a teen sees on social media often “encourages drug use or downplays the problems of drug addiction” says Selepak. This is significant because teens “spend hours every day on their phones watching videos, messaging others and being influenced by what they see on social media." Selepak adds that teens are more “influenced by what they see others doing on social media and the likes and followers other users get for engaging in ridiculous activities” than they are by a direct message from someone they don’t know, so keeping on top of what teens are viewing on social media is essential. If a teen hasn’t been persuaded by social media that drugs are not that dangerous and merely another form of low-risk fun, they are more likely to resist a direct message offering to sell them drugs.

According to psychologist Aaron Weiner, “social media plays a huge role in drug deals right now for adolescents — particularly Snapchat and Instagram.” Archer points out that “advertisements [for drugs] can be set to disappear on any time frame.” The use of stories that disappear in 24 hours to advertise is common.

Weiner adds that “teens are very savvy about how to hide their activity on social media from their parents, and there are phrases, emojis and codes that are also used to help evade detection even in the event a parent looks.” Archer says that “these code words and emojis are designed to evade detection by law enforcement used by social media platforms” as well.

Should parents monitor social media usage?

Archer is clear that “if teens have access to any smart device, the drug dealers are literally in their pocket, purse [or] backpack,” meaning that parents need to “constantly monitor” what their teen is doing on social media. Selepak recommends that parents specifically monitor how much time teens spend on social media and what content they are consuming. “Whether it is a TikTok trend to make Sleepy Chicken or eat a Tide Pod, young people are ... influenced by what they see others doing on social media,” he says.

Because many teens use apps such as Venmo, CashApp and Zelle to pay for drugs with “literally a click of a button,” Archer recommends monitoring these apps in addition to any bank accounts a teen can access.

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