Written by Hannah Harp
Spoon Feed
Polydrug overdoses that include synthetic opioids (for example, cocaine + fentanyl) are a significant and rising cause of overdose deaths for adolescents. However, death rates from synthetic opioids alone continue to rise rapidly and are still more common than polydrug + synthetic opioid deaths in this age group.
Here’s the dope
Since about 2013, we have been in a third wave of the opioid epidemic – this wave being defined by the influx of fentanyl and other synthetic opioids into the illicit drug supply. These opioids are potent and cheap, which means they are ideal to cut with heroin and (increasingly) make it easier to maintain a habit. Unfortunately, because of fentanyl’s potency, it leads more easily to opioid overdose, especially if its presence is unknown or not quantified. Fatal adolescent overdoses involving synthetic opioids doubled from 2018 to 2022, and synthetic opioid overdoses while using multiple substances are ushering in a new fourth wave of the epidemic.
This study investigated trends in synthetic-opioid-involved overdose deaths among U.S. youth aged 15-24 from 2018 to 2022 using national mortality data. A population-based retrospective analysis revealed a 167.8% increase in deaths from synthetic opioids alone (1.59 to 4.26 per 100,000). By 2022, these exceeded polydrug overdoses across all demographic groups. Male youth, American Indian/Alaska Native youth, and those aged 20-24 exhibited significantly higher mortality rates than peers. Database limitations that factor into this paper include limited racial data, absent sexuality and gender data, and the possibility of polydrug overdoses being mis- or under-coded.
How does this change my practice?
The data is eye-opening and a good reminder that anyone treating adolescents should stay up-to-date on changes in the drug supply and drug use. Let’s keep pushing good education and naloxone training, and for our kids with OUD, let’s advocate for harm-reduction and medication-assisted treatment.
Source
Changes in Synthetic Opioid-Involved Youth Overdose Deaths in the United States: 2018-2022. Pediatrics. 2025 Jun 1;155(6):e2024069488. doi: 10.1542/peds.2024-069488. PMID: 40392279
