Children poisoned by the synthetic opioid, fentanyl, has risen in the U.S. – eight years of national data shows

Incidents of children in the U.S. being poisoned by the synthetic opioid fentanyl “increased and became more severe”, a new study reveals.

Launched today as Congress continues to review the HALT Fentanyl Act, the research follows an analysis of nonfatal fentanyl pediatric (aged 0-19) exposures reported to poison centers in 49 U.S. states from 2015 through to 2023.

In total, some 3,009 cases were detailed across the eight-year period.

• In 2023 alone, 44.6% were life-threatening incidents in which there was extreme harm that could have resulted in death if not treated – an increase of these severe cases from 15.9% in 2015. 
• The majority (81.7%) of patients aged 0–12 were exposed unintentionally.
• Most patients (65.7%) aged 13–19 were noted as having used fentanyl intentionally for nonmedical purposes.
• Most incidents (1,771) were in youth aged 13–19 (58.9%), compared with 1,238 cases (41.1%) involving children aged 0-12. Males accounted for 58.5% (1,754) of all cases and females 41.5% (1,244).

The peer-reviewed findings are published in The American Journal of Drug And Alcohol Abuse, as the U.S. continues to battle a severe opioid crisis “driven by fentanyl use”.  Fentanyl with co-use of psychostimulants has come to define the “fourth wave” of the opioid crisis.

Counterfeit pills containing fentanyl “flood the illicit market”. And in recent years, seven out of every ten counterfeit pills seized contained a potentially deadly amount of fentanyl.

Since 2021, there have been over 70,000 synthetic opioid-related deaths per year; although the latest, provisional data shows such deaths are decreasing.

It is understood that friends are a major source of prescription pills among adolescents and social media, too, is commonly used to purchase drugs from strangers. Various drugs not directly purchased from a pharmacy can be adulterated with fentanyl.

Driven by a “lack of focus on nonfatal overdose and how pediatric populations are being affected,” the expert team found exposures increased over the eight years. Among those aged 0-12 this was by 924.3%. For 13- to 19-year-olds there was a 1,506% increase.

Lead author Dr. Joseph Palamar, from the Department of Population Health, at NYU Grossman School of Medicine, in New York, says their results demonstrate the need for “increased prevention, treatment, and harm reduction”.

“We can’t forget that kids are also at risk during this opioid crisis,” explains Dr. Palamar, who is also Deputy Director of the National Drug Early Warning Network (NDEWS).

“Parents need to be aware that teens can purchase pills via apps that are sold as Adderall or Xanax but actually contain fentanyl.

“Parents and others, too, need to be careful to not leave fentanyl, whether licit or illicit, out in the open around unsupervised children.

“Even second-hand exposure to paraphernalia or baggies can contain small amounts of fentanyl can be lethal to youngsters.

“Children may touch or ingest such items out of curiosity, through a lack of a sense of danger, or even imitation of a parent who uses. Even used fentanyl patches can lead to accidental or intentional poisonings among pediatric populations.”

Co-author Dr. Joshua Black, Senior Scientist at Rocky Mountain Poison & Drug Safety, a Division of Denver Health and Hospital Authority, adds: “Parents and peers need to be able to promptly detect signs and symptoms of opioid overdose—including looking pale, slow or no breathing, coma, sometimes constricted pupils—and know when to seek help.

“We encourage people to contact a poison center if they suspect a poisoning (1-800-222-1222) or call 911 if someone collapses, has a seizure, has trouble breathing, or can’t be awakened following drug use.

“Having naloxone available can reverse the potential overdose from opioids. Bystanders are present in about 40% of illicit opioid-related deaths so it is essential for bystanders to be able to respond.”

Fellow co-author Dr. Linda Cottler, Director of NDEWS, from the Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, further recommends for parents and health care providers to “be aware of the importance of receiving training about these drugs and what they do and what they look like, and how to caution teens about the dangers of friends and siblings sharing diverted drugs”.

Limitations of the research, includes that the data source used only captures a portion of fentanyl-related poisonings.

“There is a lack of systematic collection of data on nonfatal exposures and a major limitation is that most people who are exposed or overdose do not contact poison centers,” the authors report.

Research reported in this press release was supported by the National Institute on Drug Abuse of the National Institutes of Health under award numbers U01DA051126 and R01DA057289. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.