Despite a recent decrease in overdose deaths, the opioid epidemic continues to devastate the United States, with more than 100,000 lives lost in the 12-month period ending in March 2024.
While illicit drug use among adolescents has decreased, this population has experienced a stark increase in overdose deaths, with the Centers for Disease Control and Prevention (CDC) reporting a 109% increase in overdose deaths from 2019 to 2021. Overdose deaths among adolescents more than doubled from 2018 to 2022, with 22 adolescents aged 14 to 18 lost each week to an overdose in 2022—the equivalent of a high school classroom every week. During 2023, fatal opioid-related overdoses declined by 9% for adolescents. While this is positive, the nation remains ill-equipped to address the unique challenges faced by young people dealing with mental health issues, substance use, and substance use disorder (SUD).
Easier access to counterfeit pills through social media platforms and co-occurring mental health conditions exacerbate the risk of SUD and overdose among young people. Increased fentanyl availability in the drug supply has contributed to the high overdose rate among young people, with fentanyl being involved in 84% of fatal overdoses among teenagers.
Adolescents are also deeply affected by the overdose epidemic, often within their own homes. A recent study revealed that more than 321,000 U.S. children lost a parent to drug overdose between 2011 and 2021. Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that 8.7 million children aged 17 or younger live with at least one parent with an SUD. This exposure significantly increases their risk for abuse, neglect, and developing their own SUD. While the number of children in foster care declined by nearly 6% from 2021 to 2022, parental substance use is still a significant driver of children’s foster care entries. Foster care placement driven by parental SUD increased by nearly 147% nationwide between 2000 and 2017, whereas other causes of foster care placements decreased during this same period.
Despite these alarming statistics, there has been little attention to the impact of overdoses among adolescents and the broader effects of the opioid epidemic on children and families. Only 2% of federally funded studies on addiction focus on children or families. Such insufficient focus on adolescent-specific research hampers the development of effective interventions for adolescents.
SUD treatment is not one-size-fits-all, and the treatment should be tailored to meet the distinct developmental needs of adolescents, and solutions should be responsive to their unique experiences during this epidemic. Unfortunately, SUD specialty programs often lack youth-specific programming, and treatment for adolescents with SUD is scarce. Residential treatment centers for adolescents often have long waitlists and high treatment costs.
When adolescents do receive treatment for SUD, they primarily receive abstinence-based residential treatment or outpatient psychosocial therapy, both of which are associated with higher rates of dropout and return to use. Buprenorphine is a medication for opioid use disorder (MOUD) approved by the U.S. Food and Drug Administration for use among patients aged 16 and above, yet only one in four residential addiction treatment facilities for adolescents provide this medication. Less than 3 percent of adolescents who received OUD treatment were prescribed any type of MOUD, despite its association with reducing opioid misuse and improving treatment retention. This points to a broader issue of youth often experiencing worse treatment outcomes compared to adults.
Furthermore, mental health and substance use issues can often co-occur. Between 2019 and 2021, 41% of young people aged 10-19 who died of an overdose 1 had a documented mental health condition. Despite the high prevalence of mental health issues among young people, this population often faces significant barriers to mental health treatment, which can exacerbate the risk of SUD development. Structural barriers include the cost of treatment and limited availability of treatment, along with the perceived mental health stigma among young people.
The opioid epidemic among adolescents also poses significant health equity issues. As overdose deaths among adolescents increased across the board from 2018 to 2022, the largest increases were among Black and Hispanic adolescents. Drug charges account for 22% of all arrests among 18-20-year-olds, and young people of color face disproportionate rates of criminalization for SUD. This criminalization can lead to worse treatment outcomes, as punitive environments are not equipped to manage the specialized needs of young people with SUD.
The 2024 National Drug Control Strategy, developed by the federal government, aims to reduce drug use and its impact across the United States with a strong focus on the prevention and treatment of SUD among young people. The strategy recognizes the importance of both risk factors and protective factors for youth, advocating for primary prevention among youth and adolescents and linkage to evidence-based care for adolescents with SUD. This includes screening and assessment, along with linkage to care to pediatricians who provide SUD treatment.
Recommendations across the Continuum of Care
Given the current landscape, evidence-based public health and legal interventions are necessary to mitigate the effects of the opioid epidemic among adolescents. Effective strategies require collaboration among policymakers, parents, families, medical professionals, and educators.
On the prevention side of the continuum, the 2024 National Drug Control Strategy recommends expanding substance use screening of youth to both school and health care settings, along with targeted educational outreach to youth through student health services and school communities, which is crucial in early identification and intervention.
The strategy also advocates for increased harm reduction tools, including naloxone and test strips for drug checking. Naloxone is a safe and effective method for reversing overdoses, yet an underutilized tool among the adolescent population. From July 2019 to December 2021, the CDC reported that over 60% of overdose deaths among adolescents occurred at home, and potential bystanders were present about 67% of the time. However, naloxone was administered in only 30% of fatal overdoses. This data underscores the need for increased naloxone availability in schools and at home so that potential bystanders can step in with the tools necessary to take action in the event of an overdose. Multiple state legislatures passed laws this year allowing or requiring naloxone in school settings, and policymakers should continue on this path during the next legislative session.
Fentanyl is involved in 75% of adolescent overdose deaths, yet many adolescents are unaware of the proliferation of counterfeit pills. Schools and healthcare settings need to educate adolescents about fentanyl and counterfeit pills, and should also highlight the importance of harm reduction measures such as fentanyl test strips. Programs such as Prevent Overdose RI and the UNC Street Drug Analysis Lab should serve as examples for states looking to implement similar harm reduction strategies.
With respect to treatment and recovery, the existing treatment infrastructure for adolescents should expand to include an increased workforce of pediatric and adolescent addiction specialists who can meet the specialized needs of young people with SUD. The 2024 Drug Control Strategy recommends the training of additional personnel in order to address the gap of youth treatment providers. This includes mental health service providers, school psychologists, social workers, and other individuals who interact with youth in treatment settings. Treatment retention is also critical, yet nearly one-third of adolescents leave treatment before completion, with lower retention rates among Black and Hispanic adolescents. Strategies to reduce barriers to treatment while addressing health disparities can include policies such as transportation assistance, rolling admissions, and incentivizing participation by meeting people’s basic needs.
Recovery-oriented programs tailored for adolescents, such as recovery high schools and peer support programs like Young People in Recovery, provide both life skills and peer support to young people recovering from SUD. They play a pivotal role in addressing the unique challenges faced by this demographic.
The opioid epidemic is leaving no population unscathed, yet states are increasingly implementing punitive laws in response to rising overdose rates. When it comes to adolescent drug use, this trend is reminiscent of failed interventions of the past, including the infamous “Just Say No” and D.A.R.E. programs. As policymakers, public health professionals, parents, educators, and community members, we have a duty to call for evidence-based interventions that are rooted in science in order to curb the opioid epidemic among our adolescents.
DISCLAIMER: The views and opinions expressed in this piece are those of the author and do not reflect the views of the O’Neill Institute.
