Fentanyl Drives Startling Increases in Adolescent Overdose Deaths
Myron Yaster MD and Bonnie MIlas MD
Original article
Kuehn BM. Fentanyl Drives Startling Increases in Adolescent Overdose Deaths. JAMA. 2023 Jan 24;329(4):280-281. doi: 10.1001/jama.2022.23563. PMID: 36692551
Original article
Tanz LJ, Dinwiddie AT, Mattson CL, O'Donnell J, Davis NL. Drug Overdose Deaths Among Persons Aged 10-19 Years - United States, July 2019-December 2021. MMWR Morbidity and mortality weekly
Almost 107 000 Americans died from a drug overdose in 2021, continuing a 2-decade-long trend of increasing overdose deaths that accelerated during the COVID-19 pandemic.1 The consequences are just simply staggering. Life expectancy in the United States in 2021 has fallen to its lowest level since 1996 largely driven by drug overdoses and COVID-19.2
As discussed in many previous PAADs, this calamitous epidemic of drug overdose deaths is largely driven by illicitly manufactured fentanyl.3 Why? As you know from your use of fentanyl in the operating rooms, critical care, and pain management, fentanyl is rapidly acting and extremely potent both as an analgesic and as a euphoriant. Further, it produces these effects at MICROGRAM DOSES. Just think about it this way: 250 MICROGRAMS of fentanyl is less than a fraction of a grain of salt (1 grain of salt = 64 MILLIGRAMS of sodium!). Because it is so potent and so relatively easy to manufacture it has replaced heroin and more catastrophically is often used as an adulterant/additive in other drugs like psychostimulants (cocaine and methamphetamine) or in fake counterfeit copies of medicinal opioid pills like oxycodone and methadone. Thus, many fatal fentanyl overdoses occur unintentionally in individuals who did not know they were taking an opioid. In today’s PAAD, Kuehn et al.1 report a 109% increase in average monthly overdose deaths among adolescents. “Deaths involving illicitly manufactured fentanyl increased by 182% in this age group. Opioids accounted for 90% of the overdose deaths, and illicitly manufactured fentanyl accounted for 84%. Nearly a quarter of the deaths involved counterfeit pills”.1
Finally, and from our perspective the final statement of this article is the most crucial: “Bystanders were present for two-thirds of the overdoses among this adolescent age group, but in most cases, they did not attempt life-saving care. The authors recommend more education for youth about the risks of illicitly manufactured fentanyl and counterfeit pills, as well as training about and access to the opioid-overdose antidote naloxone and basic life support.”.1
As readers of the PAAD know, I’ve been advocating for more widespread use, distribution, and availability of intranasal Naloxone. I think we should be co-prescribing it with outpatient opioid prescriptions particularly in high risk patient groups like patients with sleep disordered breathing, teenagers, teenagers in the household etc. Additionally, I think we should ALL be carrying Intranasal Naloxone in our daily lives to resuscitate people we encounter outside of the hospital who have overdosed. Indeed, at the upcoming SPA MEETING we will have a booth to distribute Naloxone (and combat tourniquets) to all of the attendees. Just look for us in the exhibitors hall during meeting breaks. Further, as reported in the ASA newsletter, the ASA has expressed strong support for over the counter Naloxone and many pharmacies no longer require a prescription. Come to our booth and we’ll give it to you…there are no longer any excuses!
References
1. Kuehn BM. Fentanyl Drives Startling Increases in Adolescent Overdose Deaths. Jama. 2023;329(4):280-281. doi:10.1001/jama.2022.23563
2. Kuehn BM. US Life Expectancy in 2021 Lowest Since 1996. Jama. Jan 24 2023;329(4):280. doi:10.1001/jama.2022.23562
3. Kharasch ED, Clark JD, Adams JM. Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management. Anesthesiology. Jan 1 2022;136(1):10-30. doi:10.1097/aln.0000000000004065