Adolescent drug overdose deaths rose exponentially for the first time in history during the COVID pandemic

This is the first time in recorded history that the teen drug death rate has seen an exponential rise, even though rates of illicit drug use among teens are at all-time lows, said lead author Joseph Friedman, an addiction researcher and M.D. and Ph.D. candidate at the David Geffen School of Medicine at UCLA.

"Drug use is becoming more dangerous, not more common," Friedman said. "The increases are almost entirely due to illicit fentanyls, which are increasingly found in counterfeit pills. These counterfeit pills are spreading across the nation, and teens may not realize they are dangerous."

The study is published in JAMA.

The researchers used the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database to calculate drug overdose deaths per 100,000 population for adolescents aged 14 to 18 years that occurred from January 2010 to June 2021.

They found 518 deaths, or a rate of 2.4 per 100,000, among adolescents in 2010, and a steady rate of 492 deaths (2.36 per 100,000) each subsequent year through 2019. In 2020, there was a sharp increase to 954 deaths (4.57 per 100,000), rising to 1,146 deaths (5.49 per 100,000) in early 2021.

Broken down by ethnicity and race:

• Among American Indian/Alaska Natives, there were 11 deaths (4.86 per 100,000) in 2010 14 (6.88) through 2019, 16 (7.87) in 2020, and 24 (11.79) in 2021
• Among Black/African Americans, the numbers were 24 (0.70 per 100,000) in 2010, 46 (1.49) through 2019, 114 (3.69) in 2020, and 96 (3.10) in 2021
• Among Latinos, they were 62 (1.38) in 2010, 136 (2.68) through 2019, 276 (5.35) in 2020, and 354 (6.98) in 2021
• Among whites, they were 412 (3.32) in 2010, 281 (2.50) through 2019, 521 (4.67) in 2020, and 604 (5.36) in 2021.

A small number of individuals were from racial/ethnic groups that were not listed in the paper, or simply had missing racial/ethnicity details, which accounts for the discrepancy between the totals for deaths and rates and the racial/ethnic breakdown.

Fake versions of prescription drugs such as Xanax, Percocet and Vicodin, whose strength can fluctuate, also contributed toward the increase in overdose deaths, Friedman noted.

"Teens urgently need to be informed about this rising danger," Friedman said. "Accurate information about the risk of drugs needs to be presented in schools. Teens need to know that pills and powders are the highest risk for overdose, as they are most likely to contain illicit fentanyls. Pills and powders can be tested for the presence of fentanyls using testing strips, which are becoming more widely available."

In addition, education and access to naloxone, which can reverse overdoses, are needed in schools and places frequented by teens, he said.

The findings are limited by some factors. Among them, the observational nature of the study's design cannot establish causality, race and ethnicity may have been incorrectly assigned, 2021 results were provisional and included scaled values from January to June, and there were small numbers in some of the groups studied. Also, the role of suicidal ideation, social isolation and other factors unique to the pandemic could not be established.

The UCLA Medical Scientist Training Program, the National Institute on Drug Abuse (K01-DA050771), and the Korein Foundation funded this research.

Study co-authors are Chelsea Shover, Dr. Helena Hansen, and Dr. David Schriger of UCLA; Morgan Godvin of the Local Public Safety Coordinating Council in Portland, Oregon; and Joseph Gone of Harvard University.