Texas Health and Human Services / Texas Health Steps

Reducing Fentanyl Exposure and Overdose among Texas Youth

Opioids such as nonprescribed fentanyl have led the drug overdose crisis in the United States. “Between 2019 and 2020, the years of life lost to unintentional overdose doubled among adolescents ages 10-19.”

Gonzalez & Camenga, 2022

During that time, nonprescribed fentanyl and other novel synthetic opioids (NSOs) contributed to more than 80 percent of those deaths.

  • The pills are sold as counterfeit pharmaceutical-grade opioids, benzodiazepines (such as Xanax) and stimulants (such as Adderall), often in colorful forms to look like candy (Ibid.).

  • Lethal doses of fentanyl adulterants also are in heroin, methamphetamine and club drugs, such as ecstasy (Ibid.).

  • Laboratory testing shows that 7 of every 10 pills seized by the United States Drug Enforcement Administration (DEA, 2024) contain a lethal dose of fentanyl.

Fentanyl Abuse and Overdose in Texas

Texas youth and families are at high risk for exposure to illicit fentanyl. One in four Texans has experienced an opioid overdose or knows someone who has, according to the Texas One Pill Kills awareness campaign.

Educating about Naloxone

An AAP news article (Gonzalez & Camenga, 2022) offers guidance for healthcare providers: Start with addressing the overdose crisis with patients and families by educating them about the opioid antagonist naloxone and prescribing it when indicated.

  • Naloxone reverses opioid overdose.

  • It is easy to administer using an auto-injector or an intranasal delivery system.

  • Naloxone is safe, with minimal side effects, and “does not encourage opioid or other substance use” (Ibid.).

Naloxone, also known by the brand name Narcan, is bought without a prescription at participating pharmacies in the U.S. However, having a provider write a prescription may make having naloxone on hand more affordable for some individuals. In addition, when a healthcare provider counsels about ease of use and minimal side effects, that may help dispel myths about naloxone and reduce the stigma of overdose.

A Clinical Case Scenario

Simon 17 years

Simon, who is 17 and applying to colleges, presents at the clinic with flu-like symptoms and exhaustion. During the exam, the provider learns Simon is devoting long hours to schoolwork and extracurriculars to improve his chances of getting into college and earning a scholarship.

The provider says, “It sounds like you have a lot of late nights. Sometimes people use caffeine or other means to stay up to study at night. Do you or any of your friends use substances like stimulants to stay awake?”

Simon tells the provider that yes, a couple of his friends do, but then he shuts down. Simon’s positive response indicates he may be at risk for using unprescribed stimulants that are laced with fentanyl.

What is the provider’s next best step?

Remind Simon to ignore peer pressure to stay up for late-night studying using dangerous illicit substances.

Commend Simon for his ambition, and reflect back to him that his friends are using illicit substances that could be dangerous for them and him.

Talk to Parents and Guardians

  • Encourage parents and guardians to share concerns about substance use with children and reinforce messages about the dangers of unknown substances youths may try.

  • Counsel parents to store prescribed and over-the-counter medications in a locked medicine cabinet or out-of-reach box.

  • Connect patients and families to resources for harm reduction, which includes practical strategies and ideas aimed at reducing negative consequences of drug use.

Talk to Youth

  • Counsel adolescents about the presence and dangers of fentanyl and other novel synthetic opioids in the illicit drug supply.

  • Ask older adolescents and young adults about friends who experienced overdose and offer to prescribe naloxone to help empower them to prevent overdose deaths.

Why It Matters

Healthcare providers are empowered to save lives when they are educated about the prevalence of lethal doses of fentanyl in drugs that are available to children and adolescents. Talk to patients and families about the opioid antagonist naloxone, and prescribe it when indicated.

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References

CRAFFT (Car, Relax, Alone, Forget, Family or Friends, Trouble) Interview.

Gonzalez, L., & Camenga, D. (2022). Fentanyl a rising threat to child health: What pediatricians should know. AAP News, November 16, 2022.

National Harm Reduction Coalition.

Texas Health and Human Services. (2024). Texas Health Steps Anticipatory Guidance Provider Guide.

Texas Workforce Commission. (2024). One Pill Kills.

U.S. Drug Enforcement Administration (DEA). (2024). Drug Fact Sheet: Fentanyl.

U.S. Drug Enforcement Administration (DEA). (2024). One Pill Can Kill.