SAFE Glen Cove Coalition: Pediatric Fentanyl Poisoning

The fentanyl misuse landscape is shifting, with counterfeit prescription pills (pills made to resemble other drugs like Xanax but which contain illicit fentanyl) comprising almost half (49 percent) of seized fentanyl in the U.S. in 2023. This is alarming because younger individuals are particularly more likely to experience fatal overdoses linked to pills or even patches.

Adult deaths and drug poisoning have captured most media coverage. There has been a lack of data on fatal overdoses in pediatric populations and nonfatal fentanyl overdose in general. However, new research published in the American Journal of Drug and Alcohol Abuse discovered more than 3,000 nonfatal fentanyl poisoning cases in children from 2015 to 2023, with over one-third accidental (or unintentional). The number of recorded exposures increased by 1,194 percent from 2015 to 2023. Nonfatal pediatric exposures not only increased but also became more severe. In 2023, nearly half (44.6 percent) of incidents were life-threatening, up from 15.9 percent in 2015.

Researchers also found that most younger patients aged 0 to 12 were exposed unintentionally (81.7 percent). In contrast, among those ages 13 to 19 years, nearly two-thirds (65.7 percent) were exposed intentionally, but for nonmedical purposes.

There is a paucity of information, however, regarding the extent to which fatal pediatric poisonings have resulted from illicitly manufactured fentanyl vs. prescribed fentanyl (e.g., prescribed to a child’s caregiver and whether the use was intentional or unintentional.

For children aged 0 to 12 years of age, most fentanyl exposures (81 percent) were unintentional. In contrast, adolescents aged 13 to 19 comprised the majority (58.9 percent) of child and young adult cases. About two-thirds of these cases were intentional and by individuals who had abused or used the drugs non medically.

Children are also at risk during this opioid crisis. Parents need to be aware teens can purchase pills via apps that are sold as Adderall or Xanax but contain fentanyl. Even secondhand exposure to paraphernalia or baggies can contain small amounts of fentanyl and be lethal. 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 them. While ingestion was most prevalent across age groups, a third (33.8 percent) of adolescents in this study inhaled the drug.

Used, smoked, and discarded fentanyl patches can lead to accidental or intentional poisonings among pediatric populations. Parents and others need to be careful not to leave fentanyl, whether prescribed or not, in the open around unsupervised children. Reports indicate that even minimal amounts can be fatal to children.

The Drug Enforcement Administration (DEA) reports that 5 of every 10 of the counterfeit pills they seize contain a potentially deadly amount of fentanyl. Counterfeit pills can be pressed to resemble common drugs like alprazolam or Adderall, and “M30” pills (pressed to represent oxycodone) are particularly prevalent. In addition, various drugs not directly purchased from a pharmacy can be adulterated with fentanyl. Fentanyl, with the co-use of psychostimulants, has come to define the "fourth wave" of the opioid crisis, and smoking has increased as a preferred route of fentanyl abuse.

Fentanyl is now the primary agent noted in the pediatric opioid crisis. Mirroring trends seen among adults, pediatric deaths from fentanyl began to increase substantially, resulting in a more than 30-fold increase in mortality between 2013 and 2021. A surge that began in 2018 led to a nearly threefold increase in deaths among older adolescents and a nearly sixfold increase among children younger than 5 years. Fentanyl was implicated in more than a third (37.5 percent) of fatal pediatric opioid poisonings between 1999 and 2021.

Researchers say that most deaths were among adolescents aged 15 to 19 years (89.6 percent) and children aged 0 to 4 years (6.6 percent). For all ages, 43.8 percent of deaths occurred at home, and 87.5 percent were unintentional. A dose as small as 2 milligrams of fentanyl, equivalent to 10 to 15 grains of table salt, can be fatal.

Any pill not prescribed by a medical professional and dispensed by a licensed pharmacist can be deadly. The DEA's “One Pill Can Kill” prevention campaign is a critical initiative aimed at educating the public about the dangers of counterfeit prescription pills laced with lethal substances like fentanyl. By educating the public, (vulnerable populations like adolescents and their caregivers) through increased prevention, treatment and harm reduction, further tragedies can be prevented.

SAFE, Inc. is the only alcohol and substance abuse prevention, intervention and education agency in the City of Glen Cove. Its Coalition is conducting an opioid prevention awareness campaign entitled, "Keeping Glen Cove SAFE," to educate and update the community regarding opioid use and its consequences. To learn more about the SAFE Glen Cove Coalition please follow us on www.facebook.com/safeglencove or visit SAFE’s website to learn more about the Opioid Epidemic at www.safeglencove.org.