This is episode #6 in my series on Substance Use and Teens. This is a stand-alone episode so you can go back and listen to episodes 175 through 179 when you can.

Today I want to talk to you teens, opioids and fentanyl, including the most recent news regarding fentanyl in the US. You’ll want to hear this – stick around.

PODCAST INTRO

The DEA reports that about 75,000 people in the US died from Fentanyl in 2022.

Drug overdoses or poisonings, in general, account for about 22 deaths per week in the US for kids aged 14 to 18 and research points to much of it being driven by fentanyl being used in counterfeit pills. Almost three quarters of overdose deaths of adolescents between 2019 and 2022 involved illicit fentanyl. This is now the third largest cause of deaths for kids, right behind guns and car crashes.

Of course, the whole opioid crisis started in this country thanks to Purdue pharma and their greedy owners lying to doctors and telling them that their unique pain reliever was “less addictive and less subject to abuse and diversion than other opioids”.

Then when the US government started cracking down on prescribers, pill mills popped up all over the country where doctors were prescribing to anyone with cash to pay and if people couldn’t get it there, they turned to street opiates like heroin.

Fentanyl is a Schedule II narcotic – an opioid just like Oxycodone, Oxycontin, Percocet, Methadone, Dilaudid, and Demerol. And the high is even higher than these other opioids so it was bound to eventually be abused.

It’s completely synthetic - made from manufactured elements in a lab. It’s considered at least 50 times stronger than heroin and 100 times stronger than morphine. It’s legitimately used for cancer patients in intense pain, and to sedate people for surgery.

People who’ve been taking or abusing opioids can tolerate it much better than someone who’s never had it before….which makes it really difficult to determine a true across the board, lethal dose. It just depends on the person, if they’ve used opioids for a while, how much they weigh, and so forth. But according to the DEA, a “potentially lethal dose” is 2 milligrams of the dry fentanyl powder – that’s about the amount that will fit on the point of sharpened pencil.

But, this is extremely important to understand – there are two different types of Fentanyl - There’s legitimately manufactured, pharmaceutical grade fentanyl and there’s illicitly manufactured fentanyl.

The illicit Fentanyl is made in Mexico by amateur chemists, from precursor chemicals shipped there from China and then brought in to the US over the border by the Sinaloa and Jalisco Cartels. And of course, drug cartels don’t use nice, regulated laboratories to make their Fentanyl. They make it in warehouses, basements and garages with no standards, quality controls, nothing.

This is the Fentanyl that is mixed with other chemicals, pressed into pills that look exactly like the legitimately manufactured prescription sort, and peddled to kids on the street. Anyone can buy a pill press online that will make anything from a Xanex to a Percocet that no one can tell from the real deal.

This illicit Fentanyl is a total crap shoot – without regulations, protocols and professionals making it, no one can know the potency or if with the chemical process used, it even turns out to be Fentanyl at all.

In case you’re wondering, the reason drug cartels love using illicit Fentanyl is because it costs basically nothing to make and it’s extremely potent, so just a tiny bit goes a very long way when they cut it into other drugs they sell (like heroin or cocaine – and these fake pills). Fentanyl almost pure profit.

Our teenagers get ahold of these fake pills through social media - Snapchat delivery dealers, but also from friends, the friendly dealer at school or the neighborhood – if they want to try a pill, it doesn’t take much effort to find one. They think they’re getting Adderall, Percocet, Oxycontin, Xanax, Ecstasy (Molly/MDMA) but they’re almost always, these days, getting a fake pill made with Fentanyl.

Remember, the people making these pills are amateurs and could care less if they blend all the chemicals together thoroughly. So, this mixture of chemicals, including the Fentanyl, that they then pour into the pill press, can include clumps of straight Fentanyl, which means one pill out of a batch, can get more than others or one pill can have more fentanyl in just one part of it.

 

 

 

 

It’s called the “chocolate chip cookie effect” and it’s what makes these pills deadly.

You know when you mix up a batch of chocolate chip cookies, and you spoon them out onto the cookie sheet, you might get 3 chips in one cookie and 15 in another. Now, imagine those chocolate chips are clumps of fentanyl and the cookie is a pill. You might have one pill that ends up with little or no fentanyl or you might end up with a pill with a lethal dose of fentanyl, just in a corner of the pill. And the bottom line is, the dealer who sells this pill to your teenager, has no clue what they’re selling. They’re the bottom of the food chain – they may even be told the pills are legit, pharmaceuticals – they have no way of knowing any different (and frankly, I doubt they care as long as they’re making money).

So, no matter what someone tells your kid, even if it’s their good friend (which is often the case) the seller has no way of knowing what they’re selling your kid. Teens must understand this part. Unless a medication is prescribed for them and comes directly from their pharmacist, with their name on the bottle, they are literally playing Russian roulette with fentanyl as the bullet. They need to assume that any pill or even any other drug they get from anywhere other than from you, is deadly.

In 2022, the DEA said that of the counterfeit pills containing fentanyl they’ve tested in their laboratories, 4 out of 10 pills contain enough to potentially kill someone – 4 out of every 10 pills – those are not good odds.

According to a press release from the DEA in May 2024, “Pills tested in DEA laboratories average 2.4 mg of fentanyl, but have ranged from 0.2 mg to as high as 9 mg. The advent of fentanyl mixtures to include other synthetic opioids, such as nitazenes, or the veterinary sedative xylazine have increased the harms associated with fentanyl.”

Now, nitazene according to the University of Texas Medical Branch are, depending on the formulation, are 800 times more potent than morphine and 40 times more potent than Fentanyl! It was developed in the nineteen fifties and sixties as a substitute for morphine but the FDA refused to approve them because they were so powerful. They’ve now been classified as a schedule one drug like heroin and LSD and are illegal. It appears that at least 2,000 people may have died from nitazene since 2019.

The other drug mentioned by the DEA – xylazine is also known as “tranq” or “tranq dope” and according to the CDC, it’s not an opioid but is a sedative or tranquilizer – and it’s not approved for use at all in humans.

Both of these drugs have been found to be mixed into fake pills and powders because again, they’re cheap and increases the profit (and street value) of various other drugs.

The DEA issued a Public Safety Alert stating that “Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” said Administrator Milgram. “DEA has seized xylazine and fentanyl mixtures in 48 of 50 States. The DEA Laboratory System is reporting that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.”

So, anyway you shake it, your teenager needs to understand they are playing a deadly game if they take any pill or powder not prescribed to them.

As I mentioned earlier, drug overdoses or poisonings (because that’s what it is when you take Fentanyl or another drug not meaning to) – these cases are the third largest killer of young people in America, which at last count, doubled from 2019 to 2020.

But here’s the crazy thing, with the exception of marijuana, illicit drug use overall, among teenagers, has fallen dramatically over the past 20 years – going from 21% to 8% of 12^th graders who say they’ve used other drugs. So, it appears although fewer teens may be experimenting with various other substances (the favorites are still alcohol, weed and nicotine), the deadly nature of what they are experimenting with (counterfeit pills) has increased significantly.

Additionally, even though, again illicit drug use overall among teens has decreased, since 2000, according to the American Academy of Pediatrics, “the rates of opioid use disorder have greatly increased among children and teens.”

Of course, many of these kids who end up with a fentanyl laced pill don’t have an addiction to opioids – they’re just “experimenting” as we like to say. They feel the risk of having some fun or chilling out with a Xanex or an Oxy is worth the risk - and it can be a very dangerous bet. As a matter of fact, According to the 2019 Youth Risk Behavior Survey, an average of around 15% of all U.S. 12^th graders have taken opioids without a prescription.

Of course, there are adolescents who actually do have a substance use disorder regarding opioids and are scrambling to get them any way they can. This is a real concern as well – desperation can lead to heroin use (also known to include fentanyl). And misuse of opioids among adolescents is also associated with other negative outcomes like risk of suicide, dropping out of school, and more.

The American Academy of Pediatrics just last month issued its first ever clinical guidelines on opioids being prescribed to kids and adolescents. Why did it take them so long? Who knows.

But the APA says that doctors should prescribe opioids to kids if they need them but in conjunction with other non-opioid medicines – like acetaminophen and ibuprofen and other non-medicinal approaches like physical therapy.

Significantly, the APA says that if the doctor writes a prescription for opioids, he or she should also be writing one for naloxone (widely known as Narcan) – the life-saving rescue treatment for an opioid overdose. The APA also wants family members to receive education on how to handle the pain, the medication, and recognize the signs of an opioid overdose.

The APA says they’re trying to get this prescription issue in balance. Pediatricians, dentists, surgeons were prescribing too easily to children, then the big cutbacks happened, which they worry left many kids suffering and in pain.

The lead author of the guidelines says, “We want pediatricians to prescribe opioids when they’re needed because untreated pain can lead to distress and psychological harm. At the same time, physicians need to take steps that reduce the long-term risk for addiction.”

They want Narcan to go out with every prescription because they know they danger of taking too many by the child prescribed and the accidental overdose by others in the family.

But to set your mind at ease somewhat, again, according to the AAP, most adolescents who are prescribed opioids do not develop a disorder or overdose. It says “one-year prevalence rates for developing an opioid use disorder or experiencing an overdose after a prescription range from 0.3% to 5.8%.” I still don’t like those odds for my child, do you? I was honestly shocked when my son had his wisdom teeth removed a few years ago and they prescribed opioids.

If you have a child or teen with multiple risk factors for substance use or misuse, as I described in episode 176, I would take this into consideration and discuss it with any prescribing physician.

A I said earlier, research shows that teens can get their hands on opioids (what they think is the read deal) really quite easily. One study showed that close to half the kids who say they’ve tried opioids, get them for free and 20% got them from a friend or family member.

Signs of opioid misuse are similar to many other substance use disorders like changes in relationships, confusion and poor concentration. They also may avoid eye contact, have tiny pinpoint pupils, unexplained giggling, clumsiness, lack of coordination, slow gait, drowsiness, flushness of the face, mood changes, and changes in sleeping patterns.

According to the CDC, an opioid overdose and a fentanyl poisoning look the same – of course, the small, constricted “pinpoint” pupils; falling asleep or a decreased level of consciousness, lack of response to stimuli, slowed or shallow breathing; choking or gurgling sounds; limp body; pale, blue, or cold skin (CDC, 2021a).

If this were to happen it’s critical that naloxone be administered immediately. The name brand for naloxone is Narcan and it’s available as a nasal spray or an injector. In the US you can get it at any pharmacy, big box store and even online without a prescription. Two doses cost less than $50.

If you or anyone in your family uses opioids, you should absolutely have Narcan with you at all times. If you have a teenager – period - in my opinion, you should have Narcan. If know your kid has experimented with pills or powders like cocaine, you should have Narcan and so should they. This is not encouraging use, it’s being smart. I believe every school office, teacher, coach and administrator should have Narcan at the ready. The same for every youth organization. If I were you, I would do some checking and make sure that’s the case.

Now, here’s some good news, according to NPR, experts around the country are saying there have been fewer fentanyl poisonings and overdoses and less of the drug in the supply chain for distribution over the past 6 months. Not all experts agree but some extremely credible sources say that it appears these international crime organizations are trafficking less fentanyl and what they are selling appears to have been weakened by the use of an industrial chemical called BTMPS (which is very toxic but doesn’t cause overdoses or immediate death). At least one researcher has discovered many street samples that were using only BTMPS and no fentanyl.

These experts don’t even really understand why these gangs are using BTMPS since it doesn’t even make a user high – but it looks like it’s being added in Mexico.

Some experts think the supply chain is being impacted through international pressure on China to crackdown on precursor manufacturers there who ship it to Mexico to make the illicit fentanyl. But there are others who doubt this and think this is just a temporary issue and even doubt it’s the cause of a recent decline in deaths.

But those deaths have indeed declined over just this past year – luckily by 10% across all ages, according to the CDC. It could be that the cartels are trying to get the feds off their butt by making some changes, which would be welcomed news. But the DEA says this so-called shortage in Fentanyl is likely due to all the seizures they’ve made in 2024 and they say it’s way too early to be optimistic.

So, until opioid distribution and fentanyl dry up for good, as parents we must remain vigilant and try to help our teens understand that they cannot trust anyone to give or sell them a pill or a powder, period. And buy some Narcan – it’s $50 well spent and could give your family some peace of mind.

Alright, that’s it this week for Speaking of teens, I’ll be back next Tuesday with another episode and will be wrapping up this series soon.

If you’re getting anything from this podcast, please consider helping me reach even more parents by sharing it with your Facebook groups, parenting organizations and friends. I’m reaching you and multiple thousands of other parents – but there are millions more out there that need our help to get this information to them. I hope you’ll help me get it to them.

If you’d like more help, please come on into our Facebook group – the link is at the bottom of the episode description right where you’re listening. It’s not like many groups where you may be afraid to ask a question because of all the vitriol. I’m very proud to say there is NONE of that in our group. There are some lovely, supportive and helpful parents willing to listen and respond and I’m in there almost every day myself.

Alright, until next time, please remember to connect with your teen or tween is some small way every single day.