Teens and Counterfeit Death Pills

What we know in 2024 about drug overdoses among adolescents.

Reviewed by Michelle Quirk

Key points

• Adolescent mortality from drug overdoses is now the third leading cause of death in children under age 19.
• Teens are most at risk for taking dangerous counterfeit pills made to resemble Xanax, Adderall, or OxyContin.
• The most common barrier to managing teen OUD is a lack of annual screening, identification, and treatment.

Although I recently reported on the very good news that opioid overdose deaths are markedly down in nearly every state in the United States, we still have more than 100,000 overdose deaths per year. The number of deaths among teens and young adults, especially unsuspecting youth taking adulterated pills, continues to be a major concern. DEA Administrator Anne Milgram, appearing on 60 Minutes on September 22, 2024, said the United States was "losing a generation" to fentanyl. She also described DEA’s "One Pill Can Kill" prevention campaign.

Teens represent a small but growing portion of overall drug overdose deaths in the United States. According to Centers for Disease Control and Prevention (CDC) data, adolescents aged 15-19 accounted for around 1,146 overdose deaths in 2021, a sharp increase from previous years, with about 77 percent involving fentanyl. Drug overdose is now the third leading cause of death in children aged younger than 19 years. While teens make up less than 2 percent of total overdose deaths across all age groups, the increase in fentanyl-related fatalities among this age group is significant. The surge reflects the dangers posed by counterfeit pills laced with fentanyl, which disproportionately impact younger populations purchasing drugs through social media or other online platforms. The proliferation of counterfeit pills is complicating the illicit drug market and contributing to these deaths. In addition to fentanyl, counterfeit pills may contain other illicit drugs.

“A quarter of deaths among adolescents had evidence of counterfeit pill use, and counterfeit pills are kind of easily marketed towards adolescents via social media. Even if the user survives, counterfeit pills are often used to initiate drug use,” said Lauren Tanz, a senior scientist at the Division of Overdose Prevention at the CDC. “Most of the deaths occur at home where the deceased lives and about two thirds had somebody nearby that could have potentially intervened to prevent the overdose.”

Role of the Internet and Social Media

The internet stimulates interest in and provides a marketplace for adolescents to acquire illicit drugs and pills. Researchers have found that seeing a social media post about drugs/alcohol in the past 12 months was significantly associated with higher odds of ever using alcohol, cannabis, e-cigarettes, and multiple substances. In addition, the number of social media sites ever used was significantly associated with higher odds of ever using cannabis, cigarettes, e-cigarettes, and multiple substances.

It's sadly true kids often buy counterfeit pills laced with fentanyl through social media platforms like Snapchat, Instagram, and TikTok. Drug traffickers use these platforms to market fake pills, which resemble legitimate prescription medications such as OxyContin, Adderall, or Xanax, but are instead lethal amounts of fentanyl. The transactions often happen through private messages, making tracing harder for the DEA and other authorities.

More From Anne Milgram of the DEA

Milgram has emphasized that fentanyl in counterfeit pills is a major killer of young people in the United States. Milgram stressed that it's impacting every community in the country, contributing to a devastating drug crisis. This counterfeit pill crisis is the reason for the DEA's broader prevention campaign, "One Pill Can Kill." This campaign attempts to remind everyone fentanyl is lethal and commonly added to pills made to resemble prescription medications.

The DEA is focused on seizing millions of fentanyl-laced pills, disrupting cartel operations. They have been targeting the Mexican drug cartels, specifically the Sinaloa Cartel and the Jalisco New Generation Cartel, which are responsible for taking the primarily Chinese-manufactured fentanyl and making the lethal pills.

Unprepared Pediatricians

Another significant issue is most pediatricians feel unprepared to talk about drug use, particularly opioids. Pediatricians appear to be well behind other physicians in their knowledge and ability to screen adolescents for drugs annually. Screening adolescents annually or during health maintenance visits is necessary. This normalizes the process and makes it easier to track changes over time. Best practices emphasize effective communication, confidentiality, and using validated screening tools. Even more frequent screening may be necessary for teens with risk factors, such as a family history of substance abuse, mental health issues, or behavioral problems. Asking, "Tell me about your friends' use of substances" can help ease into more specific questions.

Researchers at Mass General, Yale School of Medicine, and the American Academy of Pediatrics analyzed results from 474 respondents to a national survey of primary care pediatricians treating adolescents. The team learned that while most pediatricians (94 percent) strongly agreed it is their responsibility to identify substance use disorders in adolescent patients, less than half (48 percent) felt prepared to counsel teens about opioids, far fewer than those who felt prepared to counsel adolescents about the use of alcohol (87 percent), cannabis (82 percent), or e-cigarette use (80 percent).

Moreover, though nearly one-quarter of pediatric doctors reported having diagnosed an adolescent with an opioid use disorder (OUD), only 5 percent ever prescribed an OUD treatment medication like buprenorphine or naltrexone, the standards of care recommended by the American Academy of Pediatrics. It is well established that mental health conditions, including substance use disorders (SUDs), are associated with premature mortality, and an early diagnosis saves lives. Substance use initiation during early adolescence is also associated with the later development of substance use and mental health disorders. Pediatricians and their offices have the chance to screen teens for drug use, smoking, and alcohol use, which is crucial in detecting early substance abuse and offering timely interventions.

“The most common barrier to managing OUD was a lack of appropriately trained personnel and behavioral health support services within pediatric practices,” according to Yale’s Deepa Camenga, MD, MHS.

Summary

Adolescents are often inadvertent users of fentanyl, buying and taking counterfeit pills containing fentanyl. Teens who use drugs are not usually diagnosed by their pediatricians, who are often unaware of their problems, don’t ask about them, and don’t know what to do if they identify an SUD. Other physician specialists have gotten up to speed during this opioid death crisis, and pediatricians need to do better.