Why parents should get Narcan and more on teen fentanyl use
Federal, state and local governments are scrambling to address the threat posed by fentanyl, a powerful synthetic opioid that has set off the deadliest drug epidemic in American history. The FDA is considering making the antidote Narcan available over the counter, states are legalizing fentanyl test strips, and local jurisdictions are holding opioid awareness and Narcan training sessions.
Parents, too, can help, say public health experts, by making sure they have Narcan nasal spray available in their home.
"It is such an important lifesaving medication, with really no side effects and no danger from using it, that everyone should just consider having it as a part of their first aid kit," said Erin McKnight, medical director of the Substance Use Treatment and Recovery Program at Nationwide Children's Hospital in Columbus, Ohio. "It's one of those things that you don't realize you need until the moment arises."
Fentanyl is a highly addictive opioid that can be manufactured legally and illegally. It is stronger, cheaper and more readily available than heroin and other opioids, leaving substance users at greater risk of overdose. A lethal dose of fentanyl for adults is 2 milligrams, compared with 30 milligrams for heroin. Children can be poisoned by much less.
One currently popular form of the drug designed to appeal to children and young adults is "rainbow fentanyl," which can come as colorful pills or as powder, or as something that looks like sidewalk chalk.
But it's not just kids who are looking for fentanyl who are in danger. Manufacturers of illicit drugs often add fentanyl to counterfeit pain, anxiety and ADHD medications to make them stronger or more addictive, which is another reason for the spike in overdoses.
Here's what else parents need to know about fentanyl and the antidote Narcan.
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How many kids are overdosing on fentanyl?
Fatal overdoses in the United States overall increased 30 percent from 2019 to 2020, and 15 percent in 2021, according to a recent report released from the Centers for Disease Control and Prevention. But among teens ages 14 to 18, the numbers were even higher: 94 percent from 2019 to 2020 and 20 percent from 2020 to 2021. About 90 percent of the fatal adolescent overdoses involved opioids and 84 percent involved illegally manufactured fentanyl.
The report attributed the rise in fatalities to the widespread availability of illicitly manufactured fentanyl drugs, counterfeit pills containing illicit fentanyl or other drugs, and the ease of purchasing pills through social media. Counterfeit pills were present in nearly 25 percent of deaths, the CDC reported.
In 2018, Yale released a study finding a nearly threefold increase in opioid poisoning mortality rates involving children over the past two decades, and the problem has only continued to worsen, according to epidemiologist Julie Gaither, an assistant professor of pediatrics at the Yale School of Medicine, who led the research.
The opioid epidemic was originally driven by prescription drugs, Gaither said, which users were told needed to be stored safely. But it is more difficult to shield children from the illicit drugs, especially because some are candy-colored and some have been purchased by users unaware that they contain fentanyl.
It takes only a minuscule amount of fentanyl to harm a child; a toddler could become unresponsive simply after touching or licking a used fentanyl patch. For that reason, Gaither believes families with children of all ages should keep Narcan in the home. "It's a very, very safe medication and it can reverse the effects of opioids very quickly and it can save lives."
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How does fentanyl cause an overdose?
Fentanyl and other opioids are chemicals that attach to special opioid receptors at the end of nerves in the brain and elsewhere in the body, starting an interaction that reduces pain and causes feelings of euphoria. If the dose is too high, however, the interaction can depress breathing, which can trigger a condition called cerebral hypoxia, in which too little oxygen reaches the brain. This can result in coma, brain damage or death.
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What are the signs of an opioid overdose?
According to Scott Hadland, chief of adolescent and young adult medicine at MassGeneral Hospital for Children and Harvard Medical School, you should watch out for a child or teenager who seems groggy. "They may have actually progressed to a point where they've lost consciousness, their breathing slows down or stops altogether, and then they begin to become pale and might develop a bluish color around the lips or their fingernails," Hadland said.
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What should you do if you think a child or teen has overdosed?
- First, try to rouse them by talking to them or seeing if they respond to pain (one suggestion: rub your knuckles on their sternum).
- If they do not respond, call 911.
- Tilt the person's head back and administer one dose of Narcan into one nostril.
- Start rescue breathing.
- If the person hasn't responded after three minutes, administer another dose of Narcan into the other nostril.
- Continue rescue breathing until the emergency medical services arrive.
- If the person does respond, put them on their side in the recovery position and wait with them until help arrives.
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How does Narcan help?
Narcan is the brand-name nasal spray form of naloxone, a medication that can reverse the effects of an opioid overdose. (Another way to administer naloxone is with Ezvio, which is an auto-injector similar to an EpiPen.) According to McKnight, who is a specialist in both adolescent and addiction medicine, Narcan is absorbed through the nasal mucosa, rapidly enters the bloodstream and goes directly to the brain, where it knocks off opioids that are attached to the opioid receptors and binds to the receptors itself. The effects last from 30 to 90 minutes, at which time the overdose can continue, which is why it's important to call 911.
Most states have Good Samaritan and naloxone access laws, which protect anyone who calls 911 or administers naloxone to an overdose victim.
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Where can I get Narcan?
Until Narcan is available over the counter, you can purchase it without a prescription from a drugstore pharmacy (usually for about $50 for a two-pack, which is generally covered by insurance, Medicare and Medicaid). You also can try obtaining it for free from state or local health departments or reach out to organizations such as the National Harm Reduction Coalition.
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Won't giving out Narcan just encourage teens to use drugs?
Hadland and other experts said this is a common but specious argument against harm-reduction efforts. For example, when public health experts encouraged putting condoms in school restrooms or giving teenagers the HPV vaccine, critics argued that these measures would result in teens having more sex. But "this is actually not what happens when these public health issues are studied," Hadland said. "And so, I think making lifesaving overdose reversal medication widely available is the right thing to do."
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Should I give my child fentanyl test strips?
Fentanyl test strips can detect the presence of fentanyl in other unregulated drugs. While they aren't helpful for users who are seeking out fentanyl, McKnight said, "there is a subset of people who are trying to find prescription opioid pills like Percocet or Vicodin or Oxycodone, or other prescription medications like Xanax and Adderall, who might not know that those pills are laced with fentanyl." Teens should know how to use the test strips to see if any of their drugs have been laced with it. One caveat: Illicitly manufactured drugs may be unevenly contaminated with fentanyl, so the bit tested with the strips may not be representative of the whole supply.
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Why are kids taking opioids?
Some kids may be experimenting, may be experiencing pain or may have grown reliant on opioids after an injury. But the CDC report showed that approximately 41 percent of the kids who overdosed had experienced mental health conditions. "Because untreated mental health and addiction are such a strong risk factor for overdose and poisoning, it's really critical that these underlying issues get addressed," said Hadland.
Treatment options for mental health and/or addictions issues are available: Parents can start their search at DrugFree.org or FindTreatment.gov.
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What are the signs that a teen might be using opioids?
Parents might come across a teen's drug paraphernalia - police suggest looking for fake soft-drink cans or similar items used to protect valuables from robbery - or notice money or valuables missing. Most adolescents, however, don't use around their parents. Instead, they "show changes in various areas of their lives - including medical or mental health problems, trouble at home, school, or work, or legal trouble," McKnight said.
According to Hadland and McKnight, parents should look out for changes such as a teen becoming withdrawn, losing interest in their usual friends or activities, performing poorly at school, having drastic mood swings or worsening mental health issues, or skipping school.
Physical signs to be aware of include drowsiness or poor responsiveness, slurred speech, heavy sweating, fatigue, itchy skin, rapid weight loss, poor hygiene, and track marks on arms or legs (a teen also may always wear long sleeves or pants to hide those).
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What else can a parent do?
Hadland emphasized the importance of having an open dialogue with kids about drugs and alcohol, including what they and their peers have experienced, and the risks. "I think that these conversations that parents should be having with their teens, by and large, are just as important as the Narcan that they want to keep in their homes."
"Don't assume your kid's not doing anything," McKnight said. "But don't assume your kid knows everything, either."
Gaither urged parents to keep their medications away from children, in a lock box if possible, and dispose of them properly by taking them back to pharmacies or to police stations. Go to dea.gov/takebackday to find a collection site.
"What I want families to know is that if anyone in the family is prescribed an opioid, or if they have an opioid use disorder, that everyone in the family is at risk," she said, "and therefore, everyone needs to be prepared."
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