More than 5,000 children and teens have died from overdoses involving fentanyl in the past two decades, according to data published Monday in JAMA Pediatrics. More than half of those deaths occurred in the first two years of the COVID-19 pandemic.
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There were about 1,550 pediatric deaths from fentanyl in 2021 -- over 30 times more than in 2013, when the wave of overdose deaths involving synthetic opioids started in the US.
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A surge that began in 2018 led to a nearly 3-fold increase in deaths among older adolescents and a nearly 6-fold increase among children younger than 5. In 2021, 40 infants and 93 children ages 1 to 4 died from a fentanyl overdose.
Since 1999, however, the vast majority of pediatric deaths from fentanyl have been among teens ages 15 to 19.
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"With older teens, the the way the poisonings occur is similar to what happens with adults. It's recreational drug use, and then they either intentionally taking fentanyl or it's being cut into the drugs that they're using," said Julie Gaither, assistant professor of pediatrics at Yale School of Medicine, who wrote the new research letter. "That's a story that's much easier to understand."
For younger kids, it's harder to get a handle on what is exactly happening inside the home -- the most common place that overdose deaths occur -- but it's often related to drugs that are left within reach.
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"With fentanyl. I mean, it's so potent it doesn't take much for them to take a lethal dose," she said.
The number of deadly poisonings among children under 5 had been decreasing since the passage of the Poison Prevention Packaging Act in 1970, when harder-to-open childproof packaging became a standard for many medicines, other studies have shown.
But illicitly used drugs like fentanyl, which is 100 times stronger than morphine and can kill quickly, don't come in childproof packaging.
The Covid-19 pandemic also exacerbated the drug epidemic, with overdose deaths reaching record levels in 2021. Fentanyl was involved in about two-thirds of overall overdose deaths for people of all ages.
Multiple drugs can be reported on one death certificate, and fentanyl is often found along with others, according to the US Centers for Disease Control and Prevention.
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Among children and teens, benzodiazepines - medications commonly prescribed to treat conditions such as anxiety and insomnia - as well as cocaine or psychostimulants were also ingested more than a third of the time, according to the new study.
These trends suggest the "pediatric opioid crisis is changing in ways that will make it harder to combat," Gaither said.
Combating the crisis will require preventative measures such as safe storage and disposal of opioids that prevent exposure, as well as harm reduction strategies including treatment for opioid use disorder for both parents and adolescents and better access to the overdose reversal drug naloxone in homes, she said.
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