Fentanyl deaths among children and teens surged during the COVID-19 pandemic, quadrupling from 2018-2021, a new study found.
By 2021, this extremely potent synthetic opioid was involved in 94% of pediatric opioid deaths, according to “National Trends in Pediatric Deaths From Fentanyl, 1999-2021,” (Gaither JR. JAMA Pediatr. May 8, 2023).
A researcher from the Yale School of Medicine analyzed Centers for Disease Control and Prevention data on children and teens under 20 years of age. She found that 13,861 youths died from opioids from 1999-2021. About 37.5% of those deaths involved fentanyl.
Teens ages 15-19 years made up 90% of the fentanyl deaths, while nearly 7% were among children under 5 years, according to the study. About 87.5% of the deaths were unintentional. In about 17% of cases, the child or teen also had ingested benzodiazepines.
Looking at the changes over time, data show there were 175 pediatric opioid deaths in 1999 and 5% involved fentanyl. In 2021, there were 1,657 pediatric opioid deaths and 94% (1,557) involved fentanyl.
The 1,557 fentanyl deaths in 2021 came as the country battled the COVID-19 pandemic, the stress of which took a significant toll on mental health. Pediatric fentanyl deaths were up that year from 1,251 in 2020, 508 in 2019 and 381 in 2018. Across those four years, the mortality rates rose 590% for children under 5 years and 290% for adolescents 15-19 years, according to the study.
“Findings from this study suggest that the pediatric opioid crisis is changing in ways that will make it harder to combat,” author Julie R. Gaither, Ph.D., M.P.H., R.N., wrote. “Commonsense solutions (eg, safe storage and disposal) are still needed to prevent pediatric exposures to opioids, but a greater emphasis on harm reduction strategies is necessary, including parental and adolescent treatment for opioid use disorder and improving access to naloxone in homes, which is where most pediatric deaths from fentanyl occur.”
Naloxone can reverse the effects of an opioid overdose. In March, the FDA granted approval to Narcan 4 milligram naloxone hydrochloride nasal spray for over-the-counter use, making it available in drugstores, grocery stores, convenience stores, gas stations and online in the coming months.
Experts from the AAP Committee on Substance Use and Prevention recommend pediatricians educate families about naloxone and help provide access to it. Pediatricians also should inform families about the dangers of fentanyl and potential presence in other illicit drugs, according to committee leaders. They can counsel families to store prescribed medications in a locked cabinet and not to keep nonprescribed drugs in the home. In addition, they can prescribe buprenorphine for adolescents and young adults diagnosed with opioid use disorder and connect them to psychosocial treatment.
Resources
- AAP policy Substance Use Screening, Brief Intervention, and Referral to Treatment
- AAP News story “Fentanyl a rising threat to child health: What pediatricians should know”
- Information on training to treat opioid use disorder in adolescents
- Information by state on civil and criminal immunity protections for naloxone prescribing and administration
- Information on finding naloxone for people who use drugs
- Information from the Providers Clinical Support System on opioid use disorder training and clinical mentoring
- Information for parents from HealthyChildren.org on opioids
- Information for parents from HealthyChildren.org on medication safety
- Information for parents from HealthyChildren.org on naloxone
