Illicit Fentanyl’s Devastating Toll on Teens and Young Adults

Allyssia Paloma’s loss of her younger brother, Mikael, to fentanyl poisoning forever changed the trajectory of her life, and too many families share the grief she experienced in communities across our country. The rise of fentanyl-related deaths in the U.S. has been staggering, particularly among young people. Illicit fentanyl, a synthetic opioid up to 50 times stronger than heroin, has flooded illegal drug markets and is laced into pills disguised as common prescription medications like Xanax, Percocet, and Adderall. For youth who experiment with drugs and others who struggle with substance use disorders, this can be fatal. After remaining fairly stable for more than a decade, overdose deaths – the majority involving fentanyl – have increased significantly over the past few years. Even though the number of teens and young adults using illicit drugs besides marijuana has actually dropped in the last twenty years, drug overdoses and poisonings are now the third-leading cause of adolescent deaths in America, following car crashes and gun-related fatalities. Fentanyl is involved in at least 75% of adolescent overdose deaths, most of which are from counterfeit pills. Data also show that the rates of illicit prescription pill misuse are highest among young adults ages 18-25.

California, like the rest of the nation, is grappling with the rise of fentanyl overdoses. Fentanyl-related overdose deaths among California’s youth ages 10-19 increased 625 percent from 2018 to 2020, and emergency department visits for non-fatal opioid overdoses more than tripled. In Sacramento County, fentanyl has had a devastating effect on the young adult population, with a 49% increase in just the last year for those ages 20-24, prompting local healthcare providers, schools, county agencies, and law enforcement to raise alarms about the increasing number of overdoses linked to fentanyl.

Risk Factors

Lack of Knowledge

Young adults and teens who die from overdose may not show any of the warning signs we typically associate with problematic substance use, such as withdrawal from peers, changes in sleep patterns and behavior, or prior problems with alcohol and other drugs. Fentanyl’s lethality means that choosing – maybe for the first time – to take one counterfeit Percocet for back pain or one counterfeit Adderall to pull an all-nighter to study for finals has fatal consequences. 

Despite what one might assume, studies show that between 2019-2021, only 1 in 10 adolescents ages 10-19 who died from a drug overdose had a history of treatment for a substance use problem, suggesting a lack of understanding about the dangers of fentanyl while underscoring the urgent need to raise awareness through prevention and harm reduction efforts. 

While youth tend to rank heroin and cocaine as considerably dangerous, many teens and, to a lesser degree, young adults do not know enough about fentanyl to recognize its deadliness. After pressure from lawmakers and citizens to address the sales of counterfeit pills on their platform, Snapchat commissioned a research survey of over 1400 teens and young adults ages 13-24. The findings reflect an uncertainty and lack of knowledge about fentanyl:

• Only 27% of teens are aware that illicit fentanyl is used in counterfeit pills, and half of young adults (50%) are aware of this issue.

• When asked to rate how dangerous various drugs are, young Americans are most likely to say heroin (61%) and cocaine (50%) are extremely dangerous, while only 37% say the same about fentanyl.

• Nearly 1 in 4 youth don’t know enough to rate fentanyl’s danger at all, the highest level of uncertainty among drugs evaluated. This lack of information about fentanyl is even more common among teens (35%).

Likewise, many teens associate pills with valid medical uses – pain, anxiety, depression, ADHD – and don’t understand the inherent danger of fake prescription pills. 

Another study suggests that teens and young adults who say they are concerned about fentanyl encounters in the community, as well as those who express concern about substance use in their own lives, are less likely to have fentanyl knowledge but more likely to know someone who will be exposed to fentanyl. This reveals a clear gap between the need for information and youth access to the information. Since we know that youth are more likely to use substances if their peers or someone else they know does, equipping them with knowledge about the risks of fentanyl is crucial so that teens and young adults, especially those who self-identify as likely to be impacted by fentanyl, have the information they need to protect themselves and others.

Presence on Social Media

Social media plays a dangerous role in the fentanyl crisis. Platforms like Snapchat, Instagram, and TikTok have become hubs where young people can access illegal substances. Drug dealers use coded language, emojis, and disappearing messages to sell counterfeit pills laced with fentanyl. This creates a precarious scenario for teens and young adults who may not realize what they’re taking. Despite efforts by social media companies to crack down on these activities, the anonymity and speed of these platforms make regulation difficult.

The DEA has identified countless cases where drug traffickers advertised with emojis and code words on e-commerce platforms and a range of social media apps. Pills are even manufactured to appeal to younger individuals – “rainbow fentanyl,” for example, is brightly colored to look like candy. As part of their One Pill Can Kill campaign, in January 2022, the DEA published their Social Media Drug Trafficking Threat, which details how illicit pills can get into the hands of vulnerable populations such as teens, young adults, and older adults who think they are getting real prescription pills. For most teens and young adults, social media is a part of their everyday lives, so exposure to drug dealers is likely.

Socioeconomic and Cultural Factors

In California and across the nation, youth from various socioeconomic backgrounds are affected by fentanyl, but certain communities and populations are at higher risk. Multiple intersecting factors can lead to even greater degrees of vulnerability.

Economically disadvantaged – Young adults and teens from low-income families are more likely to face stressful environments, including financial instability, inadequate housing, and limited access to quality education and healthcare. These conditions often increase the likelihood of engaging in drug use as a coping mechanism for stress, trauma, or mental health issues. 

In economically disadvantaged areas, where drug trafficking and crime may be more prevalent, exposure to illegal substances, including fentanyl-laced drugs, is higher. Additionally, a lack of community resources, like after-school programs, mentorship, or mental health services, further contributes to a higher risk of substance use disorders.

Minority communities – The fentanyl crisis intersects with long-standing issues of systemic racism, economic inequality, healthcare disparities, and incarceration that impact minority communities, particularly Black, Latino, and Indigenous populations. These structural inequalities compound the vulnerability of minority youth to drug exposure, as systemic barriers limit access to prevention, treatment, and recovery services. Historical and ongoing discrimination has also fueled mistrust in healthcare and law enforcement, making it harder for individuals in these communities to seek help without fear of stigma or criminalization. These factors create a perfect storm, making young adults and teens in these populations particularly vulnerable to fentanyl exposure and overdose. 

Cultural attitude towards substances – In certain communities or subcultures, there may be more permissive or ambivalent attitudes toward drug experimentation and substance use. Often, pop culture reinforces messages that downplay the risks of substance use, glorify the experience of using drugs and alcohol, and promote a sense that substance use is part of belonging and connection with others. Families with generational substance use struggles may also communicate habits and behaviors that put youth at risk. Without strong cultural messages about the dangers of fentanyl, young people may underestimate the drug’s lethal potential.

Mental health and trauma – Mental health challenges, such as anxiety, depression, and trauma, are common among young people. Exposure to trauma, including physical or emotional abuse, neglect, or violence, can increase the likelihood of substance abuse. Teens who have experienced adverse childhood experiences (ACEs) are more vulnerable to addiction, as they may turn to drugs as a way to cope with emotional pain.

However, access to mental health care is often limited, especially for those in lower socioeconomic brackets and those who are part of the LGBTQ+ community. Teens and young adults may self-medicate with opioids like fentanyl to cope with their mental health struggles, not fully understanding the risks involved.

What’s Next?

The fentanyl crisis is a complex and deadly challenge, particularly for youth. Risk factors such as lack of knowledge about fentanyl’s dangers, social media-fueled access to counterfeit drugs, and the intersection of socioeconomic and cultural factors further compound the vulnerability of young adults, especially in minority and economically disadvantaged communities. In the next installment of our documentary blog series, The Ripple Effect, we will examine the complex response to the fentanyl crisis in our communities and explore the role of stigma, harm reduction, treatment, prevention, deterrence and prosecution, and other efforts to address the problems illicit fentanyl poses.

References

California Department of Public Health. (2024, December 9). CA Overdose Dashboard. Skylab.cdph.ca.gov. https://skylab.cdph.ca.gov/ODdash/?tab=CTY

DEA. (2022, August 30). DEA warns of brightly-colored fentanyl used to target young Americans. Www.dea.gov. https://www.dea.gov/press-releases/2022/08/30/dea-warns-brightly-colored-fentanyl-used-target-young-americans

Ford, J. A., McCabe, S. E., & Schepis, T. S. (2023). Prescription drug misuse with alcohol coingestion among US adolescents: Youth experiences, health-related factors, and other substance use behaviors. Journal of Addiction Medicine, 17(4). https://doi.org/10.1097/adm.0000000000001131

Friedman, J., & Hadland, S. E. (2024). The overdose crisis among U.S. adolescents. The New England Journal of Medicine, 390(2). https://doi.org/10.1056/nejmp2312084

Gaither, J. R. (2023). National Trends in Pediatric Deaths From Fentanyl, 1999-2021. JAMA Pediatrics, 177(7). https://doi.org/10.1001/jamapediatrics.2023.0793

Goldstick, J. E., Cunningham, R. M., & Carter, P. M. (2022). Current causes of death in children and adolescents in the United States. New England Journal of Medicine, 386(20). https://doi.org/10.1056/nejmc2201761

Hadland, S., Aalsma, M. C., Akgul, S., Alinsky, R. H., Bruner, A., Chadi, N., Galagali, P. M., Kreida, E. C., Robinson, C. A., & Wilson, J. D. (2021). Medication for adolescents and young adults with opioid use disorder. Journal of Adolescent Health, 68(3), 632–636. https://doi.org/10.1016/j.jadohealth.2020.12.129

Hermans, S. P., Samiec, J., Golec, A., Trimble, C., Teater, J., & Hall, O. T. (2022). Years of life lost to unintentional drug overdose rapidly rising in the adolescent population, 2016–2020. Journal of Adolescent Health, 72(3). https://doi.org/10.1016/j.jadohealth.2022.07.004

Hoffman, J. (2022, May 19). Fentanyl tainted pills bought on social media cause youth drug deaths to soar. The New York Times. https://www.nytimes.com/2022/05/19/health/pills-fentanyl-social-media.html

King, C., Beetham, T., Smith, N. J., Englander, H., Hadland, S. E., Bagley, S. M., & P Todd Korthuis. (2023). Treatments used among adolescent residential addiction treatment facilities in the US, 2022. JAMA, 329(22), 1983–1983. https://doi.org/10.1001/jama.2023.6266

Morning Consult. (2021). Key findings from research on dangers of counterfeit drugs and fentanyl among teens and young adults. Snap, Inc. https://assets.ctfassets.net/gqgsr8avay9x/5EolnMWMUxEQdvGoMVFFJW/92e882a47bc8119aead9589ca95631dd/Dangers_of_Counterfeit_Drugs_and_Fentanyl_-_Key_Findings.pdf

Schepis, T. (2023, December 2). How dozens of U.S. adolescents are dying of drug overdoses each month, shown in 3 charts. PBS NewsHour. https://www.pbs.org/newshour/health/how-dozens-of-u-s-adolescents-are-dying-of-drug-overdoses-each-month-shown-in-3-charts

Schepis, T. S., & Krishnan-Sarin, S. (2008). Characterizing adolescent prescription misusers: A population-based study. Journal of the American Academy of Child & Adolescent Psychiatry, 47(7), 745–754. https://doi.org/10.1097/chi.0b013e318172ef0ld

Substance Abuse and Mental Health Services Administration. (2020, September 11). 2019 NSDUH detailed tables | CBHSQ data. Www.samhsa.gov. https://www.samhsa.gov/data/report/2019-nsduh-detailed-tables