Pediatric Fentanyl Poisonings Spiral Up 1,200% Over 8 Years, Study Finds
In the pediatric population aged 0 to 19 years, exposure to fentanyl was through intentional use by two-thirds, investigators found.
Nonfatal fentanyl exposures among US youth increased nearly 1,200% between 2015 and 2023, with a disturbing 44.6% of cases in 2023 causing extreme harm and classified as life-threatening—up from 15.9% in 2015. Findings are from new research published in The American Journal of Drug and Alcohol Abuse.1
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"We can't forget that kids are also at risk during this opioid crisis," lead author Joseph Palamar, MPH, PhD, associate professor in the section on tobacco, alcohol, and drug use in the department of population health at the NYU Grossman School of Medicine, said in a statement. "Parents need to be aware that teens can purchase pills via apps that are sold as Adderall or Xanax but actually contain fentanyl."2 Moreover, Palamar and colleagues cite data from the US Drug Enforcement Administration that found 7 out of every 10 counterfeit pills seized in recent years have contained a deadly amount of fentanyl.1
The peer-reviewed study analyzed 3,009 nonfatal fentanyl exposures in individuals aged 0-19 years reported to poison centers across 49 US states. Researchers found exposures increased from 69 cases in 2015 to 893 in 2023, an overall increase of 1,194% (P <.001). During the 8 years, the number of overdoses among the youngest pediatric age group (aged 0 to 12 years) increased approximately 10-fold, from 37 to 379 (924%; P <.001) and among adolescents (aged 13 to 19 years) by more than that, from 32 to 514 (1,506%; P <.001).1
Among adolescents, the researchers found that approximately two-thirds, 65.7%, intentionally used fentanyl for nonmedical purposes, while the majority (81.7%) of exposures in children under age 12 were unintentional. Boys accounted for just more than half (58.5%; 1,754) of all cases, with girls making up the remaining 41.5% (1,244), according to the results.1
Poisoning severity. Over time, the severity of poisonings has also increased substantially, the authors said. They reported that in 2015, approximately 4 out of 10 exposures (39.1%) resulted in no lasting effect while 15.9% were life threatening or led to permanent damage. By 2023, only 12.7% of exposures had no clinical effect, a decrease in benign effect of 67.7%, (P <.001) and close to half (44.6%) led to permanent effects, for an increase in personal harm of more than 170% (179.6%; P <.001).1
Routes of exposure. Exposure routes shifted over the study period, with inhalation and ingestion becoming more common while dermal and injection routes declined significantly. Use by ingestion only among children increased from 46.0% in 2015 to 85.2% in 2023 (85.3% increase, P <.001) and dermal-only use decreased from 48.7% to 3.5% (92.7% decrease, P < .001). Among the older adolescents, injection-only use decreased from 19.4% to 1.6% (a 94.1% decrease, P <.001). Additionally, 10.6% of children had concurrent benzodiazepine exposure, and 12.9% were exposed to other opioids.1
Perception of danger
Being able to recognize an overdose in progress cannot be emphasized enough, co-author Joshua Black, PhD, associate professor in the department of pharmacology at University of Colorado Anschutz and senior scientist and Rocky Mountain Poison & Drug Safety, cautioned in the statement.2 "Parents and peers need to be able to promptly detect signs and symptoms of opioid overdose—including looking pale, slow or no breathing, sometimes constricted pupils, coma—and know when to seek help."2
Pediatric exposure to fentanyl, whether the source is litic or illicit, can be the result of simple childhood curiosity, lack of a sense of danger, or even imitation of an adult, Palamar added. “Even second-hand exposure to paraphernalia or baggies that can contain small amounts of fentanyl can be lethal to youngsters.” In a more innocent setting, “even used fentanyl patches can lead to accidental or intentional poisonings among pediatric populations.”2
The findings arrive as Congress continues to review the HALT Fentanyl Act and as the US battles what experts call the "fourth wave" of the opioid crisis, characterized by fentanyl combined with psychostimulants. Since 2021, more than 70,000 synthetic opioid-related deaths have occurred annually, though provisional CDC data indicates these deaths may be decreasing.1
Study limitations included that poison center data captures only a portion of fentanyl-related poisonings, as most exposures or overdoses go unreported
For suspected poisonings, experts recommend contacting a poison center at 1-800-222-1222 or calling 911 for emergencies, noting that having naloxone available can reverse potential opioid overdoses.
