Nonfatal fentanyl exposures increase nearly 1,200% among youth

Key takeaways:

• There were 69 nonfatal fentanyl exposures in 2015 and 893 in 2023.
• Two-thirds of adolescents who were exposed to fentanyl used it intentionally.

Nonfatal fentanyl exposures increased nearly 1,200% among children and adolescents from 2015 to 2023, according to findings published in The American Journal of Drug and Alcohol Abuse.

Researchers also reported that overdoses are becoming more severe, and intentional fentanyl use among children and teens is growing.

Youth overdose deaths have risen in recent years, especially among high school-aged adolescents, and naloxone prescriptions have increased more than 600% among youth. However, little research has looked into nonfatal opioid exposures among children, according to Joseph J. Palamar, MPH, PhD, associate professor in the section on tobacco, alcohol and drug use in the department of population health at NYU Langone Health, and colleagues wrote.

“We need to focus more on pediatric overdoses,” Palamar told Healio. “This is an understudied population who is at very unique risk.”

Palamar and colleagues examined data from 3,009 nonfatal fentanyl exposures among people aged 0 to 19 years (58.5% boys) reported to poison centers between January 2015 and December 2023. They included data from every state except North Carolina. Poison centers recorded patient age and sex, route, reason for exposure and severity of symptoms.

More exposures occurred among adolescents aged 13 to 19 years (58.9%) than children aged younger than 12 years (41.1%). Palamar and colleagues reported that 54.1% of adolescents and 76.9% of younger children ingested the drug.

More than 10% of children had also been exposed to benzodiazepines (10.6%) or other opioids (12.9%).

According to the researchers, nearly 39.4% of all overdoses and 65.7% of those among adolescents involved intentional misuse or abuse. In contrast, 81.7% of overdoses among younger children were reported to be unintentional.

“It was surprising that a large portion of adolescents used fentanyl intentionally,” Palamar said. “We often think of pediatric exposures to fentanyl as being unintentional.”

The researchers reported that there were 69 overdoses in 2015 compared with 893 in 2023 — a 1,194% increase (P < .001). In that time frame, the number of overdoses among younger children increased 10-fold from 37 to 379 (924%; P < .001), and the number among adolescents increased from 32 to 514 (1,506%; P < .001).

Over the study period, Palamar and colleagues found that the proportion of exposures due to misuse or abuse increased from 26.1% to 39.2%, and unintentional exposures decreased from 47.8% to 35.4%. Inhalation and ingestion became more common over the study period, whereas dermal and injection became significantly less common.

The severity of overdoses also increased over time. In 2015, 39.1% of exposures had no effect, and 15.9% had major effects that were life-threatening or caused permanent disability. In 2023, only 12.7% had no effect and 44.6% led to major effects.

In a multivariable analysis, misuse and abuse were associated with higher rates of major medical outcomes (adjusted prevalence ratio [aPR] = 1.51; 95% CI, 1.19-1.93), as well as fentanyl ingestion (aPR = 1.23; 95% CI, 1.07-1.41).

“Pediatricians need to educate both kids and their parents about the risks associated with using pills that are not obtained from legitimate sources,” Palamar said. “Kids should never take a pill that they find somewhere, as you never know what it can contain. Parents should also keep an eye on their young children when outside to make sure they do not put anything risky in their mouths.”

References:

• Children poisoned by the synthetic opioid, fentanyl, has risen in the U.S. — eight years of national data shows. https://www.eurekalert.org/news-releases/1076087. Published March 8, 2025. Accessed March 17, 2025.
• Palamar JJ, et al. Am J Drug Alcohol Abuse. 2025;doi:10.1080/00952990.2025.2457481.