Deadly drug overdoses involving synthetic opioids alone—without the presence of other substances—surged by 168 percent among U.S. young adults aged 15 to 24 between 2018 and 2022, according to a new study published in the journal Pediatrics. The research is the first of its kind to analyze which drug combinations have driven synthetic opioid-related deaths in youth across various demographic groups.
Using data from the National Center for Health Statistics, researchers found fentanyl alone to be the leading cause of death in this age group. The rate of fatal overdoses involving only fentanyl rose from 1.6 per 100,000 in 2018 to 4.3 per 100,000 in 2022.
By comparison, overdoses involving fentanyl combined with other substances were significantly lower: the rate for fentanyl with benzodiazepines was 0.33 per 100,000 in 2022, and 0.89 per 100,000 for fentanyl mixed with cocaine. Overall, synthetic opioids accounted for 95 percent of all opioid-related deaths in this age group in 2022, around 12.3 of the 12.9 opioid deaths per 100,000.
“Before we looked at the data, we thought we would find that the majority of fatal youth overdoses involved fentanyl combined with other substances, such as prescription opioids or cocaine,” said Noa Krawczyk, PhD, and senior author of the study, in a press release. “Instead, we found the opposite—that most deaths were caused by fentanyl alone. Our analysis sheds light on the changing nature and risks of the drug supply and how they impact key demographic groups. Some may think they are taking one substance but are actually exposed to another.”
In light of the findings, Krawczyk emphasized the urgent need for youth-specific overdose prevention strategies. That includes increasing access to harm reduction services, such as naloxone, and outreach programs that meet young people where they are.
One such effort is underway in South Dakota, where the nonprofit Emily’s Hope is distributing roughly 20,000 naloxone kits across the state through a partnership with the State of South Dakota, funded by national opioid settlement dollars. The organization has also installed public naloxone distribution boxes—repurposed newspaper stands stocked with free overdose-reversal kits—at key locations statewide.
“There are a variety of ways to engage youth and reduce their risk of overdose. Schools, places of employment, homeless shelters, child welfare services, and juvenile justice settings are all possible touchpoints to offer education and harm reduction tools such as naloxone and fentanyl test strips. Our findings highlight the need to tailor these strategies to different youth groups based on the types of drugs they are using to help prevent further overdose deaths,” said Megan Miller, a lead author of the study.
