Teenagers and Counterfeit Death Pills

Anne Milgram, DEA Administrator

Source: Drug Enforcement Administration

While I recently reported the very good news that opioid overdose deaths have dropped significantly in nearly every state in the United States, we still have over 100,000 overdose deaths each year. The number of deaths among teens and young adults, particularly unsuspecting youth who swallow counterfeit pills, remains a major concern. DEA Administrator Anne Milgram, appearing on 60 Minutes on September 22, 2024, said the United States was losing “a generation” to fentanyl. She also described the DEA’s “One Pill Can Kill” prevention campaign.

Teens make up a small but growing portion of total drug overdose deaths in the United States. According to data from the Centers for Disease Control and Prevention (CDC), adolescents ages 15-19 accounted for approximately 1,146 overdose deaths in 2021, a sharp increase from previous years, with approximately 77 percent involving fentanyl. Drug overdose is now the third leading cause of death in children under 19. Although teens account for less than 2 percent of all overdose deaths across all age groups, the increase in fentanyl-related deaths in this age group is significant. The increase reflects the dangers of counterfeit fentanyl pills, which disproportionately impact younger populations who purchase drugs through social media or other online platforms. The proliferation of counterfeit pills complicates the illicit drug market and contributes to these deaths. In addition to fentanyl, counterfeit pills may contain other illicit drugs.

“A quarter of adolescent deaths had evidence of counterfeit pill use, and counterfeit pills are easily sold to adolescents via social media. Even when the user survives, counterfeit pills are often used to initiate drug use,” said Lauren Tanz, a senior scientist in the CDC’s Division of Overdose Prevention. “Most deaths occur in the home where the deceased lives, and about two-thirds had someone nearby who could have intervened to prevent the overdose.”

Lauren Tanz, senior scientist, CDC

Source: CDC

Role of the Internet and Social Media

The Internet stimulates interest in and provides a marketplace for adolescents to obtain illegal drugs and pills. Researchers found that seeing a social media post about drugs/alcohol in the past 12 months was significantly associated with a higher likelihood of lifetime use of alcohol, cannabis, e-cigarettes, and polysubstances. Furthermore, the number of the social media sites ever used was significantly associated with a higher likelihood of ever using cannabis, cigarettes, e-cigarettes, and polysubstances.

It’s unfortunately true that kids are often buying counterfeit pills laced with fentanyl through social media platforms like Snapchat, Instagram, and TikTok. Drug dealers use these platforms to sell counterfeit pills that look like legitimate prescription drugs like OxyContin, Adderall, or Xanax, but instead contain lethal amounts of fentanyl. The transactions are often conducted through private messages, making them harder for the DEA and other law enforcement to track.

More from Anne Milgram of the DEA

Milgram stressed that fentanyl in counterfeit pills is a major killer of youth in the United States. Milgram stressed that it affects every community in the country and contributes to a devastating drug crisis. This counterfeit pill crisis is the reason for the DEA’s broader prevention campaign, “One Pill Can Kill.” This campaign aims to remind everyone that fentanyl is deadly and is often added to pills that resemble prescription drugs.

The DEA is focused on seizing millions of pills of fentanyl to disrupt cartel operations. They are targeting the Mexican drug cartels, specifically the Sinaloa Cartel and the Jalisco New Generation Cartel, which are responsible for seizing the fentanyl, which is primarily produced in China, and manufacturing the deadly pills.

Unprepared Pediatricians

Another major issue is that most pediatricians feel unprepared to discuss substance use, particularly opioids. Pediatricians seem to lag far behind other physicians in their knowledge and ability to screen adolescents for drugs annually. Screening adolescents annually or during well-child visits is necessary. This normalizes the process and makes it easier to track changes over time. Best practices emphasize effective communication, confidentiality, and the use of validated screening tools. Even more frequent screening may be necessary for teens with risk factors, such as a family history of substance abuse, mental health problems, or behavioral problems. Asking, “Tell me about your friends’ substance use” can help you ask more specific questions.

Researchers from Mass General, Yale School of Medicine, and the American Academy of Pediatrics analyzed results from 474 respondents to a national survey of primary care pediatricians who treat adolescents. The team found that while most pediatricians (94 percent) strongly agreed that it is their responsibility to identify substance use disorders in adolescent patients, less than half (48 percent) felt prepared to counsel teens about opioids, far fewer than those who felt prepared to counsel teens about alcohol (87 percent), cannabis (82 percent), or e-cigarette use (80 percent).

Additionally, while nearly a quarter of pediatricians reported diagnosing an adolescent with opioid use disorder (OUD), only 5 percent ever prescribed an OUD treatment medication such as buprenorphine or naltrexone, the standards of care recommended by the American Academy of Pediatrics. It is well known that mental health conditions, including substance use disorders (SUDs), are associated with premature mortality, and early diagnosis saves lives. The onset of substance use in early adolescence is also associated with later development of substance abuse and mental health disorders. Pediatricians and their practices have the opportunity to screen teens for drug use, smoking, and alcohol use, which is critical in detecting early substance abuse and providing timely interventions.

“The most common barrier to managing OUD was a lack of well-trained staff and behavioral health support services within pediatric practices,” said Deepa Camenga, MD, MHS, of Yale.

Summary

Adolescents are often unintentional users of fentanyl, buying and taking counterfeit pills containing fentanyl. Teens who use drugs often go undiagnosed by their pediatricians, who are often unaware of their problems, don’t ask about them, and don’t know what to do if they detect an SUD. Other medical professionals have become aware of this opioid mortality crisis, and pediatricians must do better.