Unfortunately, drug misuse and overdoses have been on the rise for youth in the United States in recent years. One large contributor to that rise is the increasing availability of fentanyl — a synthetic opioid that is 100 times more powerful than morphine.
Because of its synthetic and potent nature, it’s an inexpensive way for drug cartels to offer a more powerful high by often mixing it with other illicit substances like cocaine, heroin or illegally manufactured pills made to look like a legitimate prescription medication. Young people may unknowingly buy drugs they believe to be something else, but often these other substances are being mixed with fentanyl, which can be deadly.
Codi Peterson, doctor of pharmacy at the Julia and George Argyros Emergency Department at CHOC Hospital in Orange, wants to educate parents with valuable information about fentanyl and how to detect that their children may be misusing it.
What is fentanyl?
Fentanyl is a type of medication known as an opioid, like morphine or oxycodone. Technically fentanyl is a synthetic opioid, meaning that it is manufactured in labs rather than from the poppy plant like many traditional opioid pain medications. Fentanyl acts on targets in the brain known as opioid receptors to produce feelings of pain relief as well as other effects in our body. It it extremely potent.
There are many legitimate medical uses of fentanyl, particularly to treat severe pain, typically after surgeries or during cancer treatment. It is usually administered in a controlled environment like an intensive care unit (ICU). If it is used outside of a hospital, it is usually applied as a patch that will slowly release over 72 hours, says Codi.
If medically prescribed, parents are advised to be careful when administering fentanyl to their children, and they are equipped with training to spot signs and symptoms of opioid overdose. They are also provided an antidote prescription to counter the effects of an opioid overdose if needed.
Illegal fentanyl, which can be known by its street names Dance Fever, China Girl, Apache, Tango & Cash, King Ivory and others, can be found in nasal sprays, as a powder, on blotter paper and as pills that are made to look like other prescription opioids.
Typically produced overseas and smuggled into the U.S., drug dealers will add fentanyl to heroin, cocaine and other substances to make a less-expensive drug that still produces a powerful high. Since there is no quality control or regulation with these illegal drugs, people may or may not be aware that fentanyl is being laced, or mixed, with other substances.
How are kids getting fentanyl or fentanyl-laced drugs?
Fentanyl or fentanyl-laced substances are typically sold online via eCommerce websites, social media like Snapchat or through friends. Because of advanced technology and accessibility, many substances can be available for anyone with a smartphone — including children and teens.
The greater accessibility to purchase illegal drugs online and through social media combined with the increasing presence of fentanyl in street drugs has led to more children and teens misusing fentanyl-laced substances, says Dr. Peterson. Add in the increase of mental health issues in children and teens in recent years due to the COVID-19 pandemic, substance use and overdose rates in children and teens are rising.
Why is fentanyl dangerous for children and teens?
Fentanyl acts like other opioids when it comes to the brain, interacting with opioid receptors in the central nervous system (the brain and the spinal cord), preventing the brain from receiving pain messages and producing feelings of euphoria. Fentanyl is a short-acting drug, meaning that many will feel a “high” of increased mood quickly, but it will also wear off quickly. Maintaining that “high” will require additional uses, making it highly addictive.
There are many dangerous side effects from opioids. Perhaps the most concerning side effect of all opioids is respiratory depression. This is the side effect that makes an overdose of fentanyl so deadly; the opioids block the brain’s ability to remember to breathe and can quickly lead to death. Opioids are also well known to cause the gastrointestinal tract to slow down, and many patients on opioids report significant constipation.
The biggest risk for teens misusing fentanyl is the poor quality standards these fentanyl pills are made in; poor quality control leads to variable amounts of fentanyl in each pill. This variability can mean that while one pill may be taken (usually snorted or smoked, but sometimes taken orally) with very little consequence, the next pill could have much more fentanyl and could even be deadly.
According to the Centers for Disease Control and Prevention (CDC), there were 70,630 overdose deaths in the United States. Opioids — mainly synthetic opioids like fentanyl — are currently the main driver of overdose deaths, making up 70.6% of all drug overdose deaths.
What is rainbow fentanyl?
There has been recent coverage in the news about multi-colored pills known as “rainbow fentanyl” being sold and used in several states. Of course, parents may be concerned that their teens will be attracted to these candy-like opioids. However, Dr. Peterson suggests that parents that not overly worry about the colorful versions of fentanyl, but make sure to communicate to their kids about avoiding any and all drugs.
“The truth is pretty colors are probably contributing very little to the opioid problem; it’s not the color of fentanyl that is the problem. Very few teens who are choosing to consume an addictive and potentially fatal drug will be swayed by a color,” says Dr. Peterson.
Parents should advise their kids to avoid any and all pills and powders of an unknown source — especially any drugs purchased on Snapchat or other online media. Many fentanyl pills are pressed to look like oxycodone or morphine tablets, except they contain only fentanyl. Trusting that these tablets are the drug they are impersonating can be dangerous, as fentanyl is many times as potent as most other opioids.
Avoid fentanyl by avoiding any illegally-produced tablets. Unless the tablets came from a pharmacy, it is now reasonable to assume any opioid obtained from illegal sales has the potential to be laced with fentanyl, says Dr. Peterson.
What are some signs and symptoms of fentanyl misuse?
Parents should watch for behaviors from their children that may indicate that they are looking for an escape and may be misusing fentanyl or other substances to get there. This includes:
- Withdrawing from sports or other activities that they once enjoyed.
- Dropping grades.
- Isolating themselves from friends and family.
- Spending time with new, different friends.
- A sudden change in spending habits, having less money or asking for money frequently.
The physical symptoms of fentanyl misuse will resemble the symptoms of misuse of other opioids and substances, says Dr. Peterson. He suggests that parents look for the following red flags:
- Respiratory depression, or slow and ineffective breathing.
- Slurred speech.
- Pinpoint pupils.
- Erratic behavior.
- Exhaustion or lethargy.
If you suspect that your child is misusing any opioids or other substances, reach out to your child’s school counselor, a drug counselor, mental health professional or visit your pediatrician for a substance-use screening. Your child may need to receive treatment from a drug rehabilitation center.
If you think your child has overdosed on fentanyl, call 911 or visit your nearest emergency department.
Should parents keep a prescription of naloxone, also known as Narcan, on hand in case their child overdoses?
Naloxone is an antidote prescription to counter the effects of an opioid overdose if needed. Parents of children with prescribed opioids or children suspected of abusing opioids can get a prescription for naloxone, which will be covered under most insurance plans through local pharmacies. Some charities even offer naloxone without a prescription, says Dr. Peterson.
Having naloxone, or Narcan, handy is a good idea if a parent has concerns about their child abusing opioids, says Dr. Peterson. Without this suspicion, it’s probably not necessary but could still be a good idea to keep a couple of doses around.
“The best way to prevent drug abuse, though, is to keep communication lines open between parents and children,” says Dr. Peterson.
How can parents prevent their children from misusing fentanyl or other illegal substances?
It’s better to have tough conversations about substance misuse with your kids early, rather than having to intervene after they have begun misusing substances. Codi suggests that parents keep communication open with their children by doing the following:
- Keep an open dialogue. Ask your children questions and listen without judgment.
- Pay attention to their mood, behavior and social circles. Sudden changes should be met with curiosity and not criticism.
- Personally administer any prescribed opioids or addictive medications.
- Store any medications that could be misused out of sight and discard any unused medications
- Educate your children about the dangers of opioids and other illicit drugs.
If you or someone you know is in a crisis and needs to speak with someone immediately, call the National Suicide Prevention Lifeline: 1-800-273-TALK. This is a crisis helpline that can help with a variety of issues.
They can also find support through the Substance Abuse and Mental Health Services (SAMHSA) or call 1-800-662-HELP (4357) for treatment referral. SAMHSA’s National Helpline is free and confidential, with a year-round treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
Frequently asked questions about fentanyl
Fentanyl is a type of medication known as an opioid. It is extremely potent, and is typically produced overseas and smuggled into the U.S., drug dealers will add fentanyl to heroin, cocaine and other substances to make a less-expensive drug that still produces a powerful high.
“Rainbow fentanyl” are multi-colored fentanyl pills that may look like candy. Parents should not be overly focused on warning their kids and teens to avoid rainbow fentanyl, but should warn them from taking illegal drugs entirely.
Narcan is a brand name for naloxone, an antidote prescription to counter the effects of an opioid overdose if needed. Parents can typically obtain a free prescription from local pharmacies with insurance. If parents suspect that their kids are misusing opioids, it would be helpful to have this on hand. However, communicating and supporting teens to not take illegal drugs is the best anecdote for fentanyl.
Parents should watch for behaviors from their children that may indicate that they are looking for an escape like withdrawal from activities and friends, dropping grades and new spending habits.
The physical symptoms of fentanyl misuse will resemble the symptoms of misuse of other opioids and substances like slow and ineffective breathing, lethargy and sedation, slurred speech and erratic behavior.
The biggest risk for misusing fentanyl is the poor quality standards these fentanyl pills are made in; poor quality control leads to variable amounts of fentanyl in each pill. This variability can mean that while one pill may be taken (usually snorted or smoked, but sometimes taken orally) with very little consequence, the next pill could have much more fentanyl and could even be deadly.
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The mental health team at CHOC curated the following resources on mental health topics common to kids and teens, such as depression, anxiety, suicide prevention and more.