Report Analysis

Drug Overdose Deaths Among Persons Aged 10–19 Years — United States, July 2019–December 2021

Adolescent
Demographics
Overdose
  • Published by: US Department of Health and Human Services/Centers for Disease Control and Prevention
  • Published Date: December 16, 2022
  • Link: Click here to read full report

Part One

Report Summary

The alarming increase in drug overdose deaths among U.S. adolescents has been highlighted in this report (named “Drug Overdose Deaths Among Persons Aged 10–19 Years July 2019–December 2021”) published by the US Department of Health and Human Services/Centers for Disease Control and Prevention. Despite an overall decline in illicit drug use among middle and high school students, overdose deaths in the 10-19 age group have surged, with a 30% increase from 2019 to 2020, and a further 15% increase in 2021, resulting in an estimated 108,000 deaths that year. From July 2019 to December 2021, median monthly overdose deaths among adolescents rose by 109%, indicating a stark rise in lethal incidents. 

This escalating crisis is partly attributed to the widespread availability of illicitly manufactured fentanyl (IMFs), counterfeit pills mimicking prescription drugs, and the ease of acquiring such substances via social media. The data shows that a significant 83.9% of overdose deaths involved IMFs, and approximately 24.5% featured evidence of counterfeit pills. However, a mere 35% of deceased victims had a recorded history of opioid use, suggesting a potential underestimation of drug use among the demographic. 

Notably, 40.9% of those who overdosed had indicators of mental health conditions or treatment, highlighting a crucial intersection between mental health and substance abuse. Despite the presence of potential bystanders in 66.9% of the cases, a lack of immediate response was reported in 67.8% of these incidents, primarily due to spatial separation or unawareness of drug usage. 

Illicitly manufactured fentanyls (IMFs), counterfeit pills resembling prescription drugs but containing IMFs or other illicit drugs, and the ease of purchasing pills through social media have increased fatal overdose risk among adolescents.Given the disturbing trend, urgent measures are necessary to prevent further adolescent overdose deaths. These include efforts to curb substance use initiation, reducing the availability of illicit drugs, fostering resilience among adolescents, educating about the dangers of IMFs and counterfeit pills, and providing access to naloxone training. It also calls for the expansion of treatment for substance use and mental health disorders, coupled with increased education and awareness. 

This report provides a wake-up call for a collaborative effort among public health agencies, physicians, mental health and substance use treatment providers, and educators to implement effective prevention strategies and potentially save lives.

Part Two

Key Findings

  1. Adolescent drug overdose deaths saw a significant surge from 2019 to 2021, with an increase of 109% in median monthly fatalities. A considerable part of this increase was attributed to the widespread availability of IMFs and counterfeit pills that often mimic prescription drugs but contain IMFs or other illicit substances.

  2. The majority of adolescent overdose deaths (about 84%) involved IMFs, while about a quarter of these deaths had evidence of counterfeit pills.

  3. Most overdose cases occurred in the decedent’s home, with potential bystanders present in about two-thirds of the incidents. However, due to spatial separation or unawareness of drug use, most bystanders provided no overdose response.

  4. Only 35% of adolescent decedents had documented opioid use history, indicating recent drug use initiation or lack of awareness by family and friends. Evidence of naloxone administration was present in 30% of deaths.

  5. Mental health issues were significant among the decedents, with about 41% of adolescents having documented mental health conditions or treatment. The report suggests that the increase in overdose deaths during 2020 could be linked to the decline in mental health during the COVID-19 pandemic.

  6. Treatment for substance use disorders was found to be rare among the adolescent decedents, emphasizing the urgent need for implementing effective, evidence-based substance use disorder and mental health treatments.

Part Three

Statistical Data Categorized

  • General Overdose Statistics
    • U.S. drug overdose deaths increased 30% from 2019 to 2020, and 15% in 2021, resulting in an estimated 108,000 deaths in 2021.
    • Overdose deaths among adolescents aged 14–18 years increased 94% from 2019 to 2020, and 20% from 2020 to 2021.
  • Illicitly Manufactured Fentanyls (IMFs) and Counterfeit Pills
    • The widespread availability of illicitly manufactured fentanyls (IMFs), the proliferation of counterfeit pills resembling prescription drugs but containing IMFs or other illicit drugs, and the ease of purchasing pills through social media have increased fatal overdose risk among adolescents.
    • Deaths involving IMFs increased 182% from July–December 2019 to July–December 2021.
    • Approximately 90% of overdose deaths involved opioids, and 83.9% involved IMFs.
    • Counterfeit pill evidence was present in 24.5% of overdose deaths.
  • Overdose Deaths Characteristics
    • Median monthly overdose deaths among adolescents increased 109% from July–December 2019 to July–December 2021.
    • 69.0% of adolescent overdose decedents were male, and a majority (59.9%) were non-Hispanic White persons.
    • 35% of adolescent decedents had documented opioid use history, and 14.1% had evidence of a previous overdose.
  • Mental Health Conditions
    • 40.9% of decedents had evidence of mental health conditions or treatment.
    • Approximately 41% of decedents had documented mental health history, including mental health treatment (23.8%), diagnosed depression (19.1%), or suicidal or self-harm behaviors (14.8%).
  • Overdose Circumstances
    • Potential bystanders were present in 66.9% of deaths, and 59.4% of decedents had no pulse when first responders arrived.
    • Among deaths with one or more potential bystanders present, no documented bystander response was reported for 67.8%, primarily because of spatial separation from decedents (52.9%) and lack of awareness that decedents were using drugs (22.4%).
    • Naloxone administration was documented in 30.3% of deaths.
  • Drug Use and Overdose
    • Approximately one quarter of deaths had documentation of ingestion (23.8%), smoking (23.5%), and snorting (23.0%); evidence of injection was documented in 7.8% of deaths.
    • 10.9% had evidence of substance use disorder treatment, and 3.3% had evidence of current treatment,

Please note that these numbers represent averages and trends, and actual figures might differ slightly in different jurisdictions and populations.

Part Four

Trends and Observations

  1. Increasing Rate of Overdose Deaths: There has been a sharp rise in drug overdose deaths among adolescents aged 10-19 years, with an increase of 109% from July-December 2019 to July-December 2021.

  2. Dominance of Illicitly Manufactured Fentanyls (IMFs): Overdose deaths involving IMFs increased even more dramatically during the same period, with an increase of 182%. A large proportion of overdose deaths involved opioids (91.3%) and a significant majority of these involved IMFs (83.9%).

  3. Counterfeit Pills: About a quarter (24.5%) of overdose deaths involved evidence of counterfeit pills, which often mimic the appearance of prescription drugs but contain IMFs or other illicit substances.

  4. Location and Bystander Presence: Most overdose deaths occurred at the decedent’s home (60.4%) and in the presence of potential bystanders (66.9%). However, the majority of these bystanders did not respond to the overdose, primarily due to spatial separation or lack of awareness of the decedent’s drug use.

  5. Mental Health Issues: Approximately 41% of the overdose decedents had documented mental health conditions or treatment, reflecting a link between mental health issues and risk of substance use and overdose.

  6. Declining Illicit Drug Use: Despite the increase in overdose deaths, there was a decline in overall illicit drug use among adolescents from 2019 to 2020. This suggests that the rise in overdose deaths may be driven more by the availability and potency of the drugs, particularly IMFs and counterfeit pills, rather than an increase in drug use per se.

These trends and observations underscore the urgent need for targeted intervention strategies to prevent drug misuse and overdose among adolescents, particularly strategies that address the increasing prevalence of IMFs, counterfeit pills, and mental health issues.

Part Five

Possible Prevention Strategies

  1. Enhanced Drug Education: Since the majority of overdoses involve opioids and illicitly manufactured fentanyl (IMFs), it is crucial to provide adolescents with education about the dangers of these substances, including information about counterfeit pills and their risks.

  2. Bystander Intervention: Given that most overdoses occur at home and in the presence of potential bystanders, bystander training programs can be a potential strategy for overdose prevention. These programs could teach people how to identify signs of overdose and respond effectively, including the use of naloxone, a medication designed to rapidly reverse opioid overdose.

  3. Mental Health Support: Considering the high prevalence of mental health issues among those who overdosed, it’s crucial to strengthen mental health support and intervention strategies for adolescents. This could involve providing more mental health resources in schools and communities and integrating substance use prevention into mental health treatment programs.

  4. Prevention Programs: Continued efforts should be made to prevent and reduce illicit drug use among adolescents, with a focus on risk factors identified in the report.

  5. Law Enforcement: In view of the rise in deaths associated with IMFs and counterfeit pills, there may be a need for increased regulation and enforcement to crack down on the production and distribution of these dangerous substances.

Please note that these recommendations are based on the data provided, but they might not represent the full picture or the complexities involved in addressing such a multifaceted issue. The report authors or experts in the field may have additional or alternative recommendations based on other data or research. Specific strategies and interventions should be developed and implemented in consultation with healthcare providers, public health officials, and policymakers.

Citation: U.S. Department of Health and Human Services/Centers for Disease Control and Prevention. (2022, December 16). Drug Overdose Deaths Among Persons Aged 10–19 Years — United States, July 2019–December 2021. Retrieved May 17, 2023, from https://www.cdc.gov/mmwr/volumes/71/wr/mm7150a2.htm#.